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Fibrosis of the Upper Lobes: A Newly Identified Late-Onset Complication After Lung Transplantation?

¹ Department of Medical Imaging, Toronto General Hospital, University Health Network, 200 Elizabeth St., Toronto, ON ES1-401C, Canada.
² Present address: Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
³ Toronto Lung Transplant Program, Toronto General Hospital, University Health Network, Toronto ON ES1-401C, Canada.

View larger version (94K): [in a new window]   Fig. 1A. —72-year-old woman who underwent double lung transplantation 5 years earlier because of chronic obstructive pulmonary disease. Axial high-resolution CT scan obtained 18 months after surgery at level of distal trachea shows mild bronchial dilatation. Otherwise, no significant parenchymal abnormalities are seen.

View larger version (65K): [in a new window]   Fig. 1B. —72-year-old woman who underwent double lung transplantation 5 years earlier because of chronic obstructive pulmonary disease. Axial high-resolution CT scan obtained 17 months after A at level of aortic arch shows interval appearance of extensive peripheral course reticular and patchy ground-glass opacities (arrowheads), interlobular septal thickening (short arrow), and associated severe dilatation of bronchi (long arrow).

View larger version (93K): [in a new window]   Fig. 1C. —72-year-old woman who underwent double lung transplantation 5 years earlier because of chronic obstructive pulmonary disease. Axial high-resolution CT scan obtained 19 months after B shows advancing bilateral coarse opacities with cystic changes, architectural distortion, and additional bilateral volume loss, all suggestive of lung fibrosis. Note interval appearance of persistent right pneumothorax that occurred after open lung biopsy. Arrow indicates surgical metal clip at site of lung biopsy.

View larger version (113K): [in a new window]   Fig. 2A. —38-year-old man who underwent double lung transplantation necessitated by end-stage sarcoidosis. Axial high-resolution CT scan obtained 9 months after surgery at level of aortic arch shows no significant parenchymal abnormalities.

View larger version (124K): [in a new window]   Fig. 2B. —38-year-old man who underwent double lung transplantation necessitated by end-stage sarcoidosis. Axial high-resolution CT scan obtained at same level 10 months after A shows interval appearance of bilateral peripheral interstitial opacities (arrowheads) and interlobular septal thickening (thin arrow), with associated bronchial dilatation. Thick arrow indicates interlobar fissure.

View larger version (109K): [in a new window]   Fig. 2C. —38-year-old man who underwent double lung transplantation necessitated by end-stage sarcoidosis. Axial high-resolution CT scan obtained 15 months after B shows interval anterior progression of interlobar fissure (thick arrow), suggesting further volume loss of right upper lobe. Note associated traction bronchiectasis (thin arrow).

View larger version (93K): [in a new window]   Fig. 3A. —20-year-old man who underwent double lung transplantation at age of 13 for cystic fibrosis. Axial high-resolution CT scan obtained at level of carina 43 months after transplantation shows normal lung parenchyma.

View larger version (96K): [in a new window]   Fig. 3B. —20-year-old man who underwent double lung transplantation at age of 13 for cystic fibrosis. Axial high-resolution CT scan obtained at same level as B 12 months later shows interval appearance of bilateral diffuse peripheral interstitial opacities (arrowheads) and mild septal thickening (arrow).

View larger version (89K): [in a new window]   Fig. 3C. —20-year-old man who underwent double lung transplantation at age of 13 for cystic fibrosis. Axial high-resolution CT scan obtained at same level as A and B 12 months after B shows further reduction in lung volumes, bilateral course interstitial opacities with associated traction bronchiectasis (thin arrows) and cystic changes (thick arrow) suggestive of honeycombing. Note loculated pneumothorax on left hemithorax (arrowheads).

View larger version (99K): [in a new window]   Fig. 4A. —60-year-old woman who underwent single (left) lung transplantation at age 56 for interstitial pulmonary fibrosis. Axial high-resolution CT image obtained at level of distal trachea 9 months after surgery shows normal transplanted left lung. Diffuse fibrosis in native right lung with volume loss causes shifting of mediastinum to right. Arrow indicates interlobar fissure.

View larger version (102K): [in a new window]   Fig. 4B. —60-year-old woman who underwent single (left) lung transplantation at age 56 for interstitial pulmonary fibrosis. Axial high-resolution CT scan obtained at same level 35 months after A shows interval appearance of subpleural reticular opacities mainly in left upper lobe (arrowheads), associated with traction bronchiectasis (thin arrow) and volume loss. Shift of mediastinum toward midline and interval anterior progression of interlobar fissure (thick arrow) are seen. Findings in right lung parenchyma remain mostly unchanged.

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