Intrathoracic complications following allogeneic bone marrow transplantation: CT findings.

Abstract

The authors retrospectively reviewed computed tomographic (CT) scans of 18 patients who developed 21 episodes of intrathoracic complications after allogeneic bone marrow transplantation (BMT). Pathologic and/or microbiologic diagnoses were available for all patients. All patients were immunocompromised due to either graft-versus-host disease (GVHD), neutropenia, or recurrent malignancy after BMT. CT demonstrated diagnostically relevant findings that were not apparent at radiography in 12 of the 21 cases (57%). These included a ground-glass pattern in early pneumonia (n = 5); a peripheral distribution in GVHD, bronchiolitis obliterans organizing pneumonia, and eosinophilic drug reaction (n = 4); cavitating lesions in Pneumocystis carinii pneumonia (n = 1); hemorrhagic infarcts in aspergillosis (n = 1); and mediastinal adenopathy in recurrent Hodgkin disease (n = 1). The authors conclude that chest CT is superior to radiography in demonstrating the presence, distribution, and extent of intrathoracic complications developing in patients after allogeneic BMT. CT is useful in guiding procedures for tissue diagnosis.

Use of first line bronchoalveolar lavage in the immunosuppressed oncology patient

“…HRCT has found particular application in those patients with a normal CXR but respiratory symptoms and fever. [15][16][17][18] Here, HRCT is of particular use in patients after a BMT, having a negative predictive value of 97%. 11 Other work recommends that the use of HRCT with guided BAL is the most sensitive way to diagnose pneumonia in the immunocompromised patient.…”

“…11 Other work recommends that the use of HRCT with guided BAL is the most sensitive way to diagnose pneumonia in the immunocompromised patient. 18,19 The imaging appearances on HRCT of PCP, Kaposi's sarcoma and angioinvasive fungal infections has been well characterised in patients with HIV. [20][21][22] In the oncology setting, HRCT can show characteristic findings within 30 days of bone marrow transplantation (BMT) that are strongly suggestive of the diagnosis of angioinvasive aspergillosis.…”

Angioinvasive pulmonary aspergillosis after allogeneic bone marrow transplantation: clinical and high-resolution computed tomography findings in 12 cases

“…The HRCT scan is superior to plain radiographic films in the detection and characterization of pulmonary complications after BMT. This exam is indicated in the presence of clinical manifestations of pulmonary disease with normal or unspecific radiographic findings, and for those patients who do not present clinical improvement despite adequate therapy [9,[14][15][16][17]. Therefore, the HRCT scan allows more effective investigation for patients in the period after BMT, which is of high importance in such patients whose clinical deterioration is fast and lethal.…”

“…is the commonest agent of fungal pneumonia post-BMT, being responsible for until 90% of these infections [5]. In these patients, aspergillus infection occurs in its angioinvasive pulmonary form (APA), and the diagnosis can be settled through sputum cultures, bronchoalveolar lavage or blood cultures, as well as through tissue examination of lung fragments obtained by biopsy [6][7][8][9][10]. Laboratorial confirmation of the diagnosis can delay the therapy onset, what can be fatal to these patients since this infection tends to present fulminating evolution.…”

“…Therefore, the importance of imaging investigation in such patients is widely emphasized in the literature, mostly through computed tomography (CT) scan, with the goal of identifying aspects that could suggest this diagnosis and authorizing early onset of anti-fungal therapy. The most common high resolution CT (HRCT) scan findings in patients with APA include nodules with surrounding ground glass attenuation ("halo sign"), consolidations and "air-crescent sign" [9,11,12].…”