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Radiologic Features of All-Trans-Retinoic Acid Syndrome

Jung Im Jung1, Jung Eun Choi1, Seong Tai Hahn1, Chang Ki Min2, Chun Choo Kim2 and Seog Hee Park1

1 Department of Radiology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 62 Yeouidodong, Youngdungpo—gu, Seoul 150-713, South Korea.
2 Division of Hematology, Department of Internal Medicine, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.



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  		Fig. 1A. —39-year-old man with all-trans-retinoic acid (ATRA) syndrome. Initial chest radiograph shows no abnormality.

 


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  		Fig. 1B. —39-year-old man with all-trans-retinoic acid (ATRA) syndrome. Two days after ATRA treatment, chest radiograph shows enlarged heart and congestion of pulmonary vessels. Diffuse ground-glass opacity and septal lines are noted in both lungs. Small left pleural effusion can also be seen.

 


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  		Fig. 1C. —39-year-old man with all-trans-retinoic acid (ATRA) syndrome. Follow-up chest radiograph obtained 8 days after C shows complete clearing of lung infiltrates. Treatment was done with prednisolone.

 


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  		Fig. 2A. —23-year-old woman with all-trans-retinoic acid (ATRA) syndrome and pulmonary hemorrhage. Chest radiograph obtained 12 days after ATRA treatment shows enlarged heart and diffuse ground-glass opacity in both lungs, considered to be ATRA syndrome. Patient complained of hemoptysis 4 days after prednisolone treatment. Extensive bilateral consolidations and ground-glass opacity developed in entire lung on chest radiograph, suggesting pulmonary hemorrhage. Both aspices were spared.

 


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  		Fig. 2B. —23-year-old woman with all-trans-retinoic acid (ATRA) syndrome and pulmonary hemorrhage.

 


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  		Fig. 2C. —23-year-old woman with all-trans-retinoic acid (ATRA) syndrome and pulmonary hemorrhage. High-resolution CT scan showed fuzzy centrilobular nodules and ground-glass opacity in both lungs.

 


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  		Fig. 3A. —57-year-old woman with all-trans-retinoic acid (ATRA) syndrome, progressing into acute respiratory distress syndrome. Chest radiograph 12 days after ATRA treatment shows increased cardiothoracic ratio and increased vascular pedicle width. Poorly defined nodules and ground-glass opacity are noted in entire lung and are considered to be ATRA syndrome.

 


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  		Fig. 3B. —57-year-old woman with all-trans-retinoic acid (ATRA) syndrome, progressing into acute respiratory distress syndrome. Follow-up chest radiograph 42 days after ATRA treatment. Left lung is entirely opacified and coalescent; patchy consolidations are found in right lung, suggesting acute respiratory distress syndrome.

 

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