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CT of Posttransplantation Lymphoproliferative Disorder in Pediatric Recipients of Lung Allograft

Marilyn J. Siegel1, Edward Y. Lee1, Stuart C. Sweet2 and Charles Hildebolt1

1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., St. Louis, MO 63110.
2 Department of Pediatrics, Division of Pulmonary Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110.



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  		Fig. 1. —18-year-old asymptomatic girl 2 months after lung transplantation with thoracic posttransplantation lymphoproliferative disorder and multiple pulmonary nodules. Chest CT scan shows multiple pulmonary nodules and small left pleural effusion. Large pulmonary nodule (N) is surrounded by ill-defined halo of soft-tissue attenuation. Posttransplantation lymphoproliferative disorder was not suspected clinically. Diagnosis was large cell lymphoma.

 


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  		Fig. 2. —15-year-old asymptomatic girl with thoracic posttransplantation lymphoproliferative disorder and solitary pulmonary nodule who had undergone lung transplantation 3 months earlier. Chest CT scan shows large solitary homogeneous pulmonary nodule with surrounding faint halo in left lower lobe. Posttransplantation lymphoproliferative disorder was not suspected clinically. Diagnosis was B-cell lymphoma.

 


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  		Fig. 3. —14-year-old girl with alveolar posttransplantation lymphoproliferative disorder and worsening dyspnea who had undergone bilateral lung transplantation 2 years earlier. CT scan shows areas of air-space consolidation and enlarged right paratracheal lymph node (N). Diagnosis of alveolar lymphoproliferative disorder was established by open lung biopsy. Histology finding was B-cell lymphoma.

 


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  		Fig. 4. —15-year-old boy with thoracic posttransplantation lymphoproliferative disorder and mediastinal disease who had undergone bilateral lung transplantation 4 months earlier. CT scan shows enlarged, low-attenuation right hilar lymph node (arrow) and small nodules in left upper lobe. Central low attenuation represents cavitation. Tissue sampling proved large cell lymphoma.

 


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  		Fig. 5. —17-year-old boy with abdominal posttransplantation lymphoproliferative disorder who presented with fever and abnormal results on liver function tests 4 years after transplantation. CT scan shows multiple enlarged mesenteric and retroperitoneal lymph nodes. Posttransplantation lymphoproliferative disorder of abdominal lymph nodes was proved on tissue sampling.

 


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  		Fig. 6. —11-year-old girl with abdominal posttransplantation lymphoproliferative disorder and abdominal pain 9 years after lung transplantation. CT scan shows conglomerate mass of enlarged lymph nodes (arrows) surrounding mesenteric vessels. Histology finding was large cell lymphoma.

 


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  		Fig. 7. —15-year-old girl with gastrointestinal posttransplantation lymphoproliferative disorder who presented with diarrhea and abdominal pain 7 months after bilateral lung transplantation. CT scan shows circumferential wall thickening involving small bowel (arrowheads). Small mesenteric lymph nodes are also noted adjacent to cecum. Diagnosis was large cell lymphoma.

 


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  		Fig. 8. —13-year-old girl with hepatic posttransplantation lymphoproliferative disorder and weight loss who had undergone bilateral lung transplantation 11 months earlier. CT scan shows marked hepatomegaly and multiple low-attenuation lesions in both lobes of liver. Patient also had pulmonary nodules. Tissue sampling of lung nodules proved leiomyosarcoma.

 

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