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Acute pulmonary distress following high-dose irradiation of the upper half of the body

The Radiotherapy Department, Royal Victoria Infirmary, Newcastle upon Tyne

Two cases of acute pulmonary distress following very shortly after irradiation of the upper half of the body are described. The first occurred one hour and forty minutes after irradiation and led to the patient's death three hours after irradiation. The second occurred 15 minutes after irradiation and was successfully treated with hydrocortisone and Frusemide. The features are the sudden onset of dyspnoea and cyanosis associated with pyrexia. Auscultatory evidence of pulmonary oedema was not apparent initially. The response to steroid alone is transitory.

High single-dose pulmonary irradiation causes transudation of extracellular fluid and diapedesis of red cells from the alveolar capillaries. The supervention of these effects on severely compromised pulmonary function can well prove dangerous.

Received for publication February 1, 1979. Revision received April 1, 1979.