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Pulmonary complications after bone marrow transplantation
H T Winer-Muram1, J W Gurney, P M Bozeman
1Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Abstract:
Many of the pulmonary complications that we have described have a nonspecific radiographic appearance. The most crucial information for proper interpretation of the chest radiographs is the chronologic onset of radiographic abnormalities after transplantation. Before and immediately after engraftment, local peripheral opacities accompanied by a surrounding rim of edema are regarded as fungal infections, and therapy with granulocyte transfusions and amphotericin B is initiated. Diffuse interstitial thickening is likely to represent edema, pulmonary hemorrhage, bacterial infection, or ARDS rather than CMV or P. carinii pneumonia in the neutropenic host. After engraftment, diffuse interstitial processes become the predominant lung abnormalities. In allogeneic transplant patients who are serologically positive for CMV or who receive serologically positive donor marrow for CMV, pneumonitis caused by this virus is perhaps the most common treatable lung infection. Idiopathic interstitial pneumonias present in a similar fashion to CMV pneumonia; however, the response to corticosteroid therapy is only occasionally gratifying. The onset of nodular opacities in this period may be due to a number of disorders, such as opportunistic infection, BOOP, PTLPD or recurrent tumor. Open lung biopsy usually is required for definitive diagnosis.
Insights
Interpreting post-transplant lung complications on chest radiographs relies on the timing of abnormalities. Early signs may indicate fungal infections, while later diffuse changes suggest various issues, often requiring biopsy for diagnosis.
Area of Science:
- Radiology
- Pulmonary Medicine
- Transplant Medicine
Background:
- Pulmonary complications post-transplantation often present with nonspecific radiographic findings.
- Accurate interpretation of chest radiographs is critical for timely and effective patient management.
Purpose of the Study:
- To elucidate the diagnostic significance of radiographic patterns in pulmonary complications following transplantation.
- To correlate radiographic findings with specific etiologies and treatment strategies.
Main Methods:
- Analysis of chest radiograph chronologic onset of abnormalities post-transplantation.
- Differentiation of radiographic patterns based on timing (pre-engraftment vs. post-engraftment).
- Consideration of differential diagnoses including infections, edema, hemorrhage, ARDS, and malignancy.
Main Results:
- Early peripheral opacities with edema suggest fungal infections, treated with granulocyte transfusions and amphotericin B.
- Diffuse interstitial thickening post-engraftment can indicate edema, hemorrhage, bacterial infection, ARDS, or viral infections like CMV.
- Nodular opacities post-engraftment may represent opportunistic infections, BOOP, PTLPD, or recurrent tumors.
Conclusions:
- The chronologic appearance of radiographic abnormalities is key to diagnosing pulmonary complications after transplantation.
- Cytomegalovirus (CMV) pneumonitis is a common, treatable infection in allogeneic transplant recipients.
- Open lung biopsy is often necessary for definitive diagnosis of complex or persistent pulmonary abnormalities.