[Computerized tomography in the study of thoracic-pulmonary complications after liver transplantation]

To review the role of Computed Tomography (CT) in thoracic complications following orthotopic liver transplantation (OLT).

In a post-OLT population of 567 patients transplanted in our institution, 100 patients (17.6%) were examined with chest CT. We reviewed data relative to the total number of examinations, clinical and/or radiographic indications, the CT technique--i.e., conventional (with(out) intravenous, i.v., contrast material) or high-resolution (HRCT). We also reviewed the radiologic patterns and their correlation with the other clinical, bronchoscopic and/or laboratory results.

Of 152 chest CT examinations, 45 (29.6%) were performed because of clinical indications, 31 (20.4%) because of a radiographic abnormality, 64 (42.1%) because of clinical and radiographic indications, while in 12 cases (7.9%) the reasons were unknown; 133/152 (87.5%) examinations had been performed with conventional CT scanning (100 with i.v. contrast agent and 33 without) and 19/152 (12.5%) with HRCT. Twenty of 152 (13.2%) examinations, in 16 patients, were normal; in the other 84 patients, 132/152 (86.8%) CT/HRCT studies showed 247 pathological findings (99 pleural effusions, 3 pericardial effusions, 62 cases of atelectasis, 1 pulmonary calcification, 70 suspected inflammatory parenchymal consolidations, 64 of them alveolar and 6 interstitial, 4 cases of interstitial edema and finally 8 neoplastic infiltrates).

Correlated with clinical data, CT findings are very useful in detailing clinical-radiographic screening findings, despite the limitations in typifying pleural effusions, in differentiating atelectases from inflammatory parenchymal consolidations and in assessing pneumonia etiology. Also, despite its high sensitivity (94.1%) and specificity (92.8%), CT was not accurate enough in the differential diagnosis of pneumonia. History data were necessary to characterize the histology of neoplastic infiltrates.

Chest CT has relatively uncommon, and sometimes only clinical, indications in post-OLT patients. The technique is chosen based on clinical-radiographic findings. CT proved useful in showing negative cases and in detailing clinical and radiographic findings but must be integrated with clinical findings to define inflammatory and neoplastic conditions.