J Korean Soc Radiol.  2016 Jan;74(1):8-14. 10.3348/jksr.2016.74.1.8.

Chest Radiographic Findings in Acute Paraquat Poisoning

• Na GG
• Lee MS
• Noh KH
• Kim HJ
• Sun IO

• KMID: 2150457
• DOI: http://doi.org/10.3348/jksr.2016.74.1.8

Abstract

PURPOSE
To describe the chest radiographic findings of acute paraquat poisoning.
MATERIALS AND METHODS
691 patients visited the emergency department of our hospital between January 2006 and October 2012 for paraquat poisoning. Of these 691, we identified 56 patients whose initial chest radiographs were normal but who developed radiographic abnormalities within one week. We evaluated their radiographic findings and the differences in imaging features based on mortality.
RESULTS
The most common finding was diffuse consolidation (29/56, 52%), followed by consolidation with linear and nodular opacities (18/56, 32%), and combined consolidation and pneumomediastinum (7/56, 13%). Pleural effusion was noted in 17 patients (30%). The two survivors (4%) showed peripheral consolidations, while the 54 patients (96%) who died demonstrated bilateral (42/54, 78%) or unilateral (12/54, 22%) diffuse consolidations.
CONCLUSION
Rapidly progressing diffuse pulmonary consolidation was observed within one week on follow-up radiographs after paraquat ingestion in the deceased, but the survivors demonstrated peripheral consolidation.

MeSH Terms

Eating
Emergency Service, Hospital
Follow-Up Studies
Humans
Lung
Mediastinal Emphysema
Mortality
Paraquat*
Pleural Effusion
Poisoning*
Radiography
Radiography, Thoracic*
Survivors
Thorax*
Paraquat

Figure

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  Fig. 1 A 33-year-old female who ingested 50 mL of paraquat. Chest radiograph obtained 4 days after ingestion reveals rapidly progressing diffuse consolidation in both lungs.

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  Fig. 2 A 55-year-old male who ingested 30 mL of paraquat. Chest radiograph performed 5 days after ingestion shows diffuse consolidation in both lungs with reticular density in the right lower lung.

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  Fig. 3 A 45-year-old female who survived after ingesting 15 mL of paraquat. A. 6-day follow-up radiograph reveals peripheral consolidation in both lower lungs. B. 6-month follow-up radiograph demonstrates resolution of previous peripheral consolidation in both lower lungs, with minimal residual fibrosis.

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  Fig. 4 A 47-year-old female who survived after ingesting 30 mL of paraquat. A. 3-day follow-up radiograph shows subtle opacities in both basal lungs. B. 8-day follow-up image demonstrates aggravated multifocal consolidations in both lungs, especially the perepheral portions. C. Chest CT scan obtained 7 weeks after ingestion shows consolidation and dilatation of bronchial structures from fibrotic change. D. One year follow-up image shows residual fibrosis in both lungs.

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  Fig. 5 A 33-year-old female who ingested 350 mL of paraquat. Chest radiograph obtained 3 days after ingestion shows diffuse consolidation in bilateral middle and lower lungs with pneumomediastinum.

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