RADIATION-INDUCED PULMONARY VENOOCCLUSIVE DISEASE

Late occurrence of radiation-induced pulmonary pneumonitis and fibrosi s is well documented. We report an unusual case of radiation induced v eno-occlusive disease (VOD) occurring six years following mantle irrad iation for Hodgkin's lymphoma. The patient developed severe pulmonary hypertension and cor pulmonale. A left lung transplantation was perfor med successfully and pathologic examination of the explanted lung show ed severe changes compatible with VOD. In the absence of exposure to a lternate therapeutic or toxic agents that may cause VOD, it is likely that radiation caused damage to the venular endothelium and caused pro gressive obliteration of the pulmonary vessels. Review of the literatu re reveals only a few similar reports of VOD mostly following radiatio n for bone marrow transplantation. We conclude that previous irradiati on (even several years earlier) should be considered as a possible cau se of pulmonary VOD.