Chronic Lung Allograft Dysfunction: Review of CT and Pathologic Findings

Area of Science:

• Radiology
• Pulmonary Medicine
• Transplant Surgery

Background:

• Chronic lung allograft dysfunction (CLAD) is the primary cause of mortality in lung transplant recipients beyond the first year.
• CLAD is traditionally categorized into obstructive (bronchiolitis obliterans syndrome) and restrictive (restrictive allograft syndrome) forms.
• CLAD can present with diverse imaging and pathological findings, including combined obstructive and restrictive physiological abnormalities.

Purpose of the Study:

• To review the evolution of CT findings in CLAD.
• To emphasize the underlying pathogenesis and pathology of CLAD.
• To familiarize radiologists with CT findings for early diagnosis and treatment of obstructive, restrictive, and mixed CLAD forms.

Main Methods:

• Review of CT imaging findings in CLAD.
• Correlation of imaging findings with underlying pathogenesis and pathology.
• Emphasis on initial and follow-up CT manifestations.

Main Results:

• Initial CT findings in CLAD can be nonspecific.
• Progressive CT findings on follow-up studies are crucial for suspecting CLAD.
• Imaging abnormalities may precede the development of functional lung allograft abnormalities.

Conclusions:

• Early diagnosis of CLAD through CT imaging is vital.
• Understanding the spectrum of CT findings aids in identifying obstructive, restrictive, and mixed CLAD.
• Timely diagnosis and treatment of CLAD can potentially improve patient survival.