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Radiation Fibrosis — RACP Adult Medicine MCQ

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ModerateRespiratoryRadiation FibrosisRACP Adult Medicine

A 60-year-old man presents with progressive exertional dyspnoea and dry cough. He had radiation therapy to the chest for lymphoma 15 years ago. Spirometry shows a restrictive pattern. HRCT shows upper-lobe predominant fibrosis with sharp margins corresponding to previous radiation fields. What is the most likely diagnosis?

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Correct answer: A — Radiation fibrosis

Pulmonary fibrosis confined to previous radiation fields (sharp geometric margins) with onset years after radiation therapy is radiation fibrosis. It is a late complication of thoracic radiotherapy. No specific treatment exists; management is supportive. It must be distinguished from recurrent lymphoma (which would show mass-like lesions and respond to PET).

Reference: eTG Respiratory – 2024 – Radiation Lung Injury