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4. 1 and 3
The repeat thoracic CT scan shows that the mass present in Figure 1 has disappeared but there is consolidation in the left upper lobe and the superior subsegment of the left lower lobe. Her chronic symptoms of cough are nonspecific but more suggestive or radiation pneumonitis than an acute infection. Radiation pneumonitis usually occurs 2-3 months after therapy and can be mild or severe. Symptoms include may include cough, shortness of breath, low grade fever or chest pain and can be indistinguishable from infectious pneumonitis. Although empiric antibiotics will likely do her no harm, her mild symptoms with rather marked lung consolidation is more suggestive of radiation pneumonitis than infectious pneumonia.
She underwent bronchoscopy with transbronchial biopsies which showed only “organizing pneumonitis” without organisms being seen. She was felt to most likely have radiation pneumonitis.
Which of the following is the generally recommended therapy for radiation pneumonitis? (Click on the correct answer to proceed to the third of six pages)