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Na, Lee, Noh, Kim, and Sun: Chest Radiographic Findings in Acute Paraquat Poisoning
Chest Radiology

Journal of the Korean Society of Radiology 2016; 74(1): 8-14.

Published online: 6 January 2016

DOI: https://doi.org/10.3348/jksr.2016.74.1.8

Chest Radiographic Findings in Acute Paraquat Poisoning

Gyeong Gyun Na, MD1, Mi Sook Lee, MD1, Kyung Hee Noh, MD1, Hee Jun Kim, MD1, In O Sun, MD2

1Department of Radiology, Presbyterian Medical Center, Jeonju, Korea.

2Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea.

Corresponding author: Mi Sook Lee, MD. Department of Radiology, Presbyterian Medical Center, 365 Seowon-ro, Wansan-gu, Jeonju 54987, Korea. Tel. 82-63-230-2185, Fax. 82-63-230-8387, ms0928l@nate.com

Received 7 July 2015       Revised 1 September 2015       Accepted 25 September 2015

Copyright © 2016 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Paraquat, Poisoning, Radiography, Lung

Figures and Tables

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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Table 1

Summary of Chest Radiographic Findings of Paraquat Poisoning

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No. of Patients (n = 56) (%)
Abnormal findings of X-ray
 Diffuse consolidation 29 (51.7)
 Peripheral consolidation 2 (3.5)
 Consolidation + linear, nodular, reticular opacity 18 (32.1)
 Consolidation + pneumomediatinum 7 (12.5)
Extent of involvement*
 Grade 1 (1-2) 12 (21.4)
 Grade 2 (3-4) 25 (44.6)
 Grade 3 (5-6) 19 (33.9)
Distribution
 Bilateral lung involvement 44 (78.6)
 Unilateral lung involvement 12 (21.4)
Pleural effusion 17 (30.4)
Pneumothorax 2 (3.6)

*The scoring of extent of involvement is based on two dimentional area of the one lung where involving one-third (–33%) = 1 point, one-third to two-third (33–67%) = 2 points, two-third or higher (67–100%) = 3 points.

1 or 2 points = grade 1, 3 or 4 points = grade 2, 5 or 6 points = grade 3

Table 2

Frequency and Distribution of Abnormality on Chest Radiographs in 56 Patients with Paraquat Poisoning

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Survivor Non-Survivor p-Value
Number of patients 2 54 -
Male:female 0:2 42:12 0.059
Age (years) 46 53 0.799
Paraquat amount (mL) 22.5 117.5 0.416
Extent of involvement* > 0.999
 Grade 1 (1-2) 2 10
 Grade 2 (3-4) 0 25
 Grade 3 (5-6) 0 19
Pleural effusion 2 15 0.088
Pneumomediastinum 0 7 > 0.999
Pneumothorax 0 2 > 0.999

*The scoring of extent of involvement is based on two dimentional area of the one lung where involving one-third (–33%) = 1 point, one-third to two-third (33–67%) = 2 points, two-third or higher (67–100%) = 3 points. 1 or 2 points = grade 1, 3 or 4 points = grade 2, 5 or 6 points = grade 3

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