Pneumology - Reviews

Amiodarone-induced pulmonary toxicity: case series and review of clinical-radiological correlations

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Published: 16 July 2026
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Amiodarone is an effective and commonly used anti-arrhythmic drug. The radiographic presentations of amiodarone-induced pulmonary toxicity (AIPT) include a broad spectrum of patterns. Three main clinical-radiographic presentations are described with AIPT: isolated reduction of diffusing lung capacity with no clinical implications; alveolar-interstitial pneumonia, which usually requires amiodarone discontinuation and corticosteroid treatment; and acute respiratory distress syndrome, which can obviously be life-threatening. We report 6 cases that depict the described range of clinical and radiographic presentations. The analysis of the cases and of the published review suggests that the computed tomography scan pattern on presentation predicts well the clinical course. The correlation between radiographic and clinical findings can therefore guide the clinician in the management of AIPT.

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Wolkove N, Baltzan M. Amiodarone pulmonary toxicity. Can Respir J 2009;16:43-8.
Sapp JL, Wells GA, Parkash R, et al. Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N Engl J Med 2016;375:111-21.
Harris L, McKenna WJ, Rowland E, et al. Side effects of long-term amiodarone therapy. Circulation 1983;67:45-51.
Greene HL, Graham EL, Werner JA, et al. Toxic and therapeutic effects of amiodarone in the treatment of cardiac arrhythmias. J Am Coll Cardiol 1983;2:1114-28.
Smith WM, Lubbe WF, Whitlock RM, et al. Long-term tolerance of amiodarone treatment for cardiac arrhythmias. Am J Cardiol 1986;57:1288-93.
Dusman RE, Stanton MS, Miles WM, et al. Clinical features of amiodarone-induced pulmonary toxicity. Circulation 1990;8:51-9.
Kang IS, Kim KJ, Kim Y, et al. The diagnostic utility of chest computed tomography scoring for the assessment of amiodarone-induced pulmonary toxicity. Korean J Intern Med 2014;29:746-53.
Tsaban G, Ostrovsky D, Alnsasra H, et al. Amiodarone and pulmonary toxicity in atrial fibrillation: a nationwide Israeli study. Eur Heart J 2024;45:379-88.
Kwok WC, Ma TM, Chn JWM, et al. A multicenter retrospective cohort study on predicting the risk for amiodarone pulmonary toxicity. BMC Pulm Med 2022;22:128.
Jackevicius CA, Tom A, Essebag V, et al. Population-level incidence and risk factors for pulmonary toxicity associated with amiodarone. Am J Cardiol 2011;108:705-10.
Yamada Y, Shiga T, Matsuda N, et al. Incidence and predictors of pulmonary toxicity in Japanese patients receiving low-dose amiodarone. Circ J 2007;71:1610-6.
Singh SN, Fletcher RD, Fisher SG, et al. Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure. N Engl J Med 1995;333:77-82.
Gleadhill IC Wise RA, Schonfeld SA, et al. Serial lung function testing in patients treated with amiodarone: a prospective study. Am J Med 1989;86:4-10.
Javot L, Pape E, Yelehe-Okouma M, et al. Intravenous single administration of amiodarone and breastfeeding. Fundam Clin Pharmacol 2019;33:367-72.
Adams PC, Holt DW, Storey GC, et al. Amiodarone and its desethyl metabolite: tissue distribution and morphologic changes during long-term therapy. Circulation 1985;72:1064-75.
Papiris S, Triantafillidou C, Kolikas L, et al. Amiodarone: review of pulmonary effects and toxicity. Drug Saf 2010;33:539-58.
Allen JE, Goodman DB, Besarab A, et al. Studies on the biochemical basis of oxygen toxicity. Biochim Biophys Acta 1973;320:708-28.
Myers JL, Kennedy JI, Plumb VJ. Amiodarone lung: pathologic findings in clinically toxic patients. Hum Pathol 1987;18:349-54.
Kudenchuk PJ, Pierson DJ, Greene HL, et al. Prospective evaluation of amiodarone pulmonary toxicity. Chest 1984;86:541-8.
Dake MD, Madison JM, Montgomery CK, et al. Electron microscopic demonstration of lysosomal inclusion bodies in lung, liver, lymph nodes, and blood leukocytes of patients with amiodarone pulmonary toxicity. Am J Med 1985;78:506-12.
Singh SN, Fisher SG, Deedwania PC, et al. Pulmonary effect of amiodarone in patients with heart failure. The Congestive Heart Failure-Survival Trial of Antiarrhythmic Therapy (CHF-STAT) Investigators (Veterans Affairs Cooperative Study No. 320). J Am Coll Cardiol 1997;30:514-7.
Pollak PT. Clinical organ toxicity of antiarrhythmic compounds: ocular and pulmonary manifestations. Am J Cardiol 1999;84:37R-45R.
Jessurun GA, Boersma WG, Crijns HJ. Amiodarone-induced pulmonary toxicity. Predisposing factors, clinical symptoms and treatment. Drug Saf 1998;18:339-44.
Tsai IL, Huang LT, Yu YT, et al. Variable radiographic and histologic presentations of amiodarone-related interstitial lung disease and the importance of avoiding re-exposure. Respirol Case Rep 2023;11:e01165.
Griffith C, Hossain S, Minupuri A, et al. Nodules that wax and wane: unusual presentation of amiodarone lung toxicity. Cureus 2020;12:e9058.
Carvalho JG, Fernandes C, Franca M. Organizing pneumonia secondary to amiodarone treatment. Heliyon 2022;8:e10630.
Kennedy JI, Myers JL, Plumb VJ, et al. Amiodarone pulmonary toxicity. Clinical, radiologic, and pathologic correlations. Arch Intern Med 1987;147:50-5.
Coudert B, Bailly F, Lombard JN, et al. Amiodarone pneumonitis. Bronchoalveolar lavage findings in 15 patients and review of the literature. Chest 1992;102:1005-12.
Chen J, Hinton S. Acute amiodarone interstitial toxicity presenting as unilateral pneumonitis. BMJ Case Rep 2021;14:e247597.
Wilson BD, Clarkson CE, Lippmann ML. Amiodarone-induced pulmonary inflammation. Correlation with drug dose and lung levels of drug, metabolite, and phospholipid. Am Rev Respir Dis 1991;143:1110-4.
Greenspon AJ, Kidwell GA, Hurley W, et al. Amiodarone-related postoperative adult respiratory distress syndrome. Circulation 1991;84:III407-15.
Kay GN, Epstein AE, Kirklin JK, et al. Fatal postoperative amiodarone pulmonary toxicity. Am J Cardiol 1988;62:490-2.
Van Mieghem W, Coolen L, Malysse I, et al. Amiodarone and the development of ARDS after lung surgery. Chest 1994;105:1642-5.
Wood DL, Osborn MJ, Rooke J, et al. Amiodarone pulmonary toxicity: report of two cases associated with rapidly progressive fatal adult respiratory distress syndrome after pulmonary angiography. Mayo Clin Proc 1985;60:601-3.
Donaldson L, Grant IS, Naysmith MR, Thomas JS. Acute amiodarone-induced lung toxicity. Intensive Care Med 1998;24:626-30.
Feduska ET, Thoma BN, Toryman MC, et al. Acute amiodarone pulmonary toxicity. J Cardiothorac Vasc Anesth 2021;35:1485-94.
Siniakowicz RM, Narula D, Suster B, et al. Diagnosis of amiodarone pulmonary toxicity with high-resolution computerized tomographic scan. J Cardiovasc Electrophysiol 2001;12:431-6.
Heath MF, Costa-Jussa FR, Jacobs JM, et al. The induction of pulmonary phospholipidosis and the inhibition of lysosomal phospholipases by amiodarone. Br J Exp Pathol 1985;66:391-7.
Saussine M, Colson P, Alauzen M, et al. Postoperative acute respiratory distress syndrome. A complication of amiodarone associated with 100 percent oxygen ventilation. Chest 1992;102:980-1.
Carmichael LC, Newman GH. Lymphocytic pleural exudate in a patient receiving amiodarone. Br J Clin Pract 1996;50:228-30.
Polverosi R, Zanellato E, Doroldi C. Thoracic radiography and high resolution computerized tomography in the diagnosis of pulmonary disorders caused by amiodarone. Radiol Med 1996;92:58-62.
Arnon R, Raz I, Chajek-Saul T, et al. Amiodarone pulmonary toxicity presenting as a solitary lung mass. Chest 1988;93:425-7.
Milbrandt EB, Byron Jr W, Davis B. Progressive infiltrates and eosinophilia with multiple possible causes. Chest 2000;118:230-4.
Distefano G, Fanzone L, Palermo M, et al. HRCT patterns of drug-induced interstitial lung diseases: a review. Diagnostics 2020;10:244.
Sweidan A, Singh NK, Dang N, et al. Amiodarone-induced pulmonary toxicity - a frequently missed complication. Clin Med Insights Case Rep 2016;9:91-4.
Al Heyasat A, Chaudhry MS, Qasim A, et al. Amiodarone-induced pulmonary toxicity presenting as hypoxemic respiratory failure in a patient with ventricular tachycardia: a case report. Cureus 20256;17:e83564.
Nicholson AA, Caplin JL, Steventon DM. Measurement of tissue-bound amiodarone and its metabolites by computed tomography. Clin Radiol 1994;49:14-8.
Tun MM, Pandey S, Adhikari S, et al. Amiodarone-induced liver attenuation on CT scan: alarming signal for toxicity and prompt discontinuation. Cureus 2023;15:e39844.
Pollak PT, Sharma AD, Carruthers SG. Relation of amiodarone hepatic and pulmonary toxicity to serum drug concentrations and superoxide dismutase activity. Am J Cardiol 1990;65:1185-91.
Chang HY, Chang YL, Hung CS. Amiodarone induced concurrent severe hepatic and pulmonary injuries - a case report. Acta Cardiol Sin 2022;38:646-9.

Ethics Approval

This study was approved by the research ethics board of Western University (protocol n.101386 “Interstitial lung disease database”).

How to Cite



“Amiodarone-Induced Pulmonary Toxicity: Case Series and Review of Clinical-Radiological Correlations”. 2026. Monaldi Archives for Chest Disease, July. https://doi.org/10.4081/monaldi.2026.3936.