Background and objectives: Therapeutic agents for cancer can cause unique pulmonary toxicities and mimic other conditions. The advent of new targeted molecular and immune therapies has changed the landscape of cancer treatment. These adverse events pose diagnostic and therapeutic challenges. This review aims to summarize the clinical presentations, radiographic patterns, and management strategies for noninfectious pulmonary complications associated with cancer therapies. Materials and methods: A literature review was conducted focusing on drug-induced lung injury (DILI), radiation-induced lung injury (RILI), pleural disease, pulmonary vascular complications, and other inflammatory conditions in patients with cancer. The data sources included clinical trials, guideline recommendations, observational studies, and expert consensus addressing incidence, pathophysiology, imaging findings, and treatment approaches. Results: Noninfectious pulmonary sequelae of anti-neoplastic therapies encompass a broad spectrum of etiologies. DILI occurs in up to 30% with variable onset and severity. The patterns can be diverse but include interstitial pneumonitis, organizing pneumonia, and diffuse alveolar damage. RILI is common and influenced by the radiation dose, volume, and concurrent therapies, and it may have both acute and chronic clinical and radiographic presentations. Pleural disease may arise from radiation and other agents, and the determination of etiology can impact management. Pulmonary vascular disease arises from many different etiologies, including therapies such as tyrosine kinase inhibitors and proteosome inhibitors, thromboembolic disease, as well as rare processes, including pulmonary veno-occlusive disease. Other conditions such as transfusion-related lung injury, cryptogenic organizing pneumonia, and interstitial lung abnormalities can also further complicate the diagnosis. Conclusions: Noninfectious pulmonary complications related to cancer therapies are diverse and often indistinguishable from infectious or malignant processes. The integration of clinical history, imaging, and selective invasive testing are needed for a timely diagnosis. Management typically involves withdrawal of the offending agent and corticosteroids, with immunosuppressive therapy reserved for severe or refractory cases. The awareness of these entities and early recognition are critical to optimizing outcomes.

This patient has a complex medical history that includes intellectual disability, blindness, deafness, seizure disorder, tracheomalacia, and recurrent aspiration. He had a percutaneous endoscopic gastrostomy in place for tube feeding. He again presented with acute respiratory distress, hypoxemia, fever, and leukocytosis. Chest computed tomography (CT) revealed bilateral infiltrates and nodular densities. A previous chest CT done 6 years prior to admission revealed multiple micronodules scattered throughout both lung fields. The patient had had a previous lung biopsy 20 years prior to admission which revealed lentil starch material in bronchioles and multifocal foreign body giant cell reactions. The patient was treated with an empiric antibiotic regimen and improved. This case demonstrates the radiographic and histologic changes associated with lentil pneumonia which is an unusual type of aspiration pneumonia. Keywords: Lentil pneumonia, granulomas, aspiration, nodules