A women w/ recently treated breast cancer presents with dry cough and worsening lung infiltrates despite antibiotics, ultimately diagnosed with radiation pneumonitis.
*Take home points: Recognize radiation pneumonitis as a cause of dry cough + infiltrates appearing 1-12 months after thoracic or neck radiation. Infiltrates are usually ipsilateral but can be contralateral to radiation. Diagnose by excluding other causes including infection, malignancy, thromboembolic disease, drug-induced (these patients are at risk for all). Once confirmed, can monitor CXRs q4-6 weeks to make sure it resolves spontaneously or treat if symptomatic (steroids).*