Effects of radiation therapy on the lung: radiologic appearances and differential diagnosis

Radiographics. 2004 Jul-Aug;24(4):985-97; discussion 998. doi: 10.1148/rg.244035160.


Radiation-induced lung disease (RILD) due to radiation therapy is common. Radiologic manifestations are usually confined to the lung tissue within the radiation port and are dependent on the interval after completion of treatment. In the acute phase, RILD typically manifests as ground-glass opacity or attenuation or as consolidation; in the late phase, it typically manifests as traction bronchiectasis, volume loss, and scarring. However, the use of oblique beam angles and the development of newer irradiation techniques such as three-dimensional conformal radiation therapy can result in an unusual distribution of these findings. Awareness of the atypical manifestations of RILD can be useful in preventing confusion with infection, recurrent malignancy, lymphangitic carcinomatosis, and radiation-induced tumors. In addition, knowledge of radiologic findings that are outside the expected pattern for RILD can be useful in diagnosis of infection or recurrent malignancy. Such findings include the late appearance or enlargement of a pleural effusion; development of consolidation, a mass, or cavitation; and occlusion of bronchi within an area of radiation-induced fibrosis. A comprehensive understanding of the full spectrum of these manifestations is important to facilitate diagnosis and management in cancer patients treated with radiation therapy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / radiotherapy
  • Adult
  • Aged
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / pharmacology
  • Breast Neoplasms / radiotherapy
  • Bronchiectasis / diagnostic imaging
  • Bronchiectasis / etiology
  • Carcinoma, Non-Small-Cell Lung / diagnostic imaging
  • Carcinoma, Non-Small-Cell Lung / radiotherapy
  • Diagnosis, Differential
  • Disease Progression
  • Dose Fractionation, Radiation
  • Esophageal Neoplasms / radiotherapy
  • Female
  • Hodgkin Disease / radiotherapy
  • Humans
  • Lung / radiation effects*
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / radiotherapy
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnostic imaging
  • Neoplasms, Radiation-Induced / diagnosis
  • Radiation Injuries / diagnosis
  • Radiation Injuries / diagnostic imaging*
  • Radiation Pneumonitis / diagnostic imaging*
  • Radiation Pneumonitis / etiology
  • Radiation Tolerance / drug effects
  • Radiography
  • Radiotherapy / adverse effects*
  • Radiotherapy / methods
  • Radiotherapy Dosage
  • Radiotherapy, Conformal / adverse effects


  • Antineoplastic Agents