Computed tomography findings of postoperative complications in lung transplantation

Abstract

improved as a result of advances in surgical technique, careful harvesting/preservation of donor organs, improvements in immunosuppressive therapy and earlier recognition of complications with the use of various imaging techniques. The reported one-, five-, ten-and fifteen-year survival rates are 75%, 50%, 35% and 25%, respectively. (3,4) The most common cause of mortality in the first 6 months is bacterial infection, which is thereafter supplanted by chronic graft dysfunction. The clinical and radiological manifestations of postoperative complications can be nonspeLung transplantation has become an established technique for the treatment of end-stage pulmonary diseases in adults.(1,2) The number of transplantations performed annually and the number of centers performing lung transplantations continue to increase.(1,2) Although single lung transplantation was previously more common, double lung transplantation is currently the preferred option for all patients with end-stage pulmonary disease, due to the better long-term survival of patients submitted to the latter procedure. AbstractDue to the increasing number and improved survival of lung transplant recipients, radiologists should be aware of the imaging features of the postoperative complications that can occur in such patients. The early treatment of complications is important for the long-term survival of lung transplant recipients. Frequently, HRCT plays a central role in the investigation of such complications. Early recognition of the signs of complications allows treatment to be initiated earlier, which improves survival. The aim of this pictorial review was to demonstrate the CT scan appearance of pulmonary complications such as reperfusion edema, acute rejection, infection, pulmonary thromboembolism, chronic rejection, bronchiolitis obliterans syndrome, cryptogenic organizing pneumonia, posttransplant lymphoproliferative disorder, bronchial dehiscence and bronchial stenosis.Keywords: Tomography, X-ray computed; Lung transplantation; Postoperative complications. ResumoCom o número cada vez maior e uma melhor sobrevida dos pacientes submetidos ao transplante pulmonar, os radiologistas devem estar cientes das diversas possibilidades de complicações associadas ao transplante de pulmão. O tratamento precoce das complicações é importante para a sobrevida a longo prazo dos receptores de transplante pulmonar. Com frequência, a TCAR desempenha um papel central na investigação de tais complicações. O reconhecimento precoce dos sinais de complicações proporciona um tratamento rápido e melhora a sobrevida. O objetivo desta revisão pictórica foi proporcionar uma visão sobre as complicações mais prevalentes na TC, tais como edema de reperfusão, rejeição aguda, infecção, tromboembolismo pulmonar, rejeição crônica, síndrome da bronquiolite obliterante, pneumonia em organização criptogênica, doença linfoproliferativa pós-transplante, deiscência brôn-quica e estenose brônquica Descritores: Tomografia computadorizada por raios X; Transplante de pulmão; Complicações...

Clinical features of post-infectious bronchiolitis obliterans in children undergoing long-term azithromycin treatment

“…Imaging techniques, particularly HRCT, play an important role in the diagnosis of PIBO (17,18). A number of characteristics are observed on PIBO-positive HRCT scans, including patchy ground-glass opacity, air retention, bronchial wall thickening, bronchiectasis, mosaic perfusion and a unilateral hyperlucent lung (19). Air retention syndrome has the highest sensitivity and accuracy in the diagnosis of BO.…”

Cardiopulmonary magnetic resonance imaging in children after lung transplantation: Preliminary observations

“…7 An aspect that is unique to lung transplantation in pediatric recipients is the issue of graft growth. Although a study by Ro et al, 8 using serial CT scans, suggested that tracheal growth in lung transplant recipients may be similar to that in normal children, insufficient growth at the bronchial anastomosis sites remains a potential substrate for the development of stenosis late after transplantation.…”

Practical Approach to Emergencies in Lung Transplant Recipients: How We Do It

“…A chest X-ray may only show features suggestive of advanced stages of rejection (bronchiectasis, pleural effusion) or help detect alternative diagnoses such as cardiac failure [26]. Since the early diagnosis and treatment of infection or rejection is essential, HRCT images are evaluated to make alternative diagnoses and choose the location for biopsy sampling at bronchoscopy, with subsequent sample assessment by a transplant-experienced pathologist [20,26,27,28]. HRCT alone is not sufficiently specific and sensitive to reliably diagnose rejection.…”

“…In acute rejection, HRCT findings may include ground-glass opacities (often with basal distribution), peribronchial cuffing, septal thickening and new or more extensive pleural effusion. In chronic rejection, dilated bronchi, bronchiectasis, mosaic attenuation and air trapping (on expiratory scans, more pronounced in the lower lobes) may be observed [27,29]. Bronchoscopic biopsies may contribute to the tissue diagnosis of acute rejection [29,30].…”

“…Fungal infections are common in LTRs and sometimes occur despite apparently adequate antifungal prophylaxis. In the work-up of severe deterioration of pulmonary function, HRCT imaging and bronchoscopic sampling are required for the diagnosis of allograft rejection or infection, for example invasive fungal infection [26,27,28,29,52]. When additional antifungal treatment is required, we prefer caspofungin due to its favourable safety profile.…”