Raymond Murphy, M.D., D.Sc., M.P.H., and Andrey Vyshedskiy, Ph.D. N Engl J Med 2010; 363:e31 November 11, 2010
A 77-year-old woman presented to the hospital with shortness of breath and fever, 2 months after receiving radiation therapy to the right chest for breast cancer. A diagnosis of radiation pneumonitis was made, and the patient was treated with glucocorticoids.
Serial chest radiography revealed irregular opacifications, predominantly in the right hemithorax (as seen on the third day after admission [Panel A] and the fifth day [Panel B]). The opacifications decreased markedly after treatment (as seen on day 72 [Panel C]). A lung-sound recorder was used for auscultation of 14 sites on the thorax. The results of the sound analysis are shown as three-dimensional models (Panels D, E, and F, corresponding to days 3, 5, and 28, respectively). The corresponding animations and audio recordings (available with the full text of this article at NEJM.org) show localization of the crackles (indicated in green) in the right hemithorax corresponding to the opacifications seen on radiography. The crackles decreased markedly after treatment.
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