High-Resolution CT and Pathologic Findings of Noninfectious Pulmonary Complications After Hematopoietic Stem Cell Transplantation
Tomás Franquet1,
Nestor L. Müller2,
Kyung Soo Lee3,
Ana Giménez1 and
Julia D. Flint4
1 Department of Radiology, Hospital de Sant Pau, Universitat Autónoma de
Barcelona, Avda Sant Antoni M. Claret 167, Barcelona 08025, Spain.
2 Department of Radiology, Vancouver Hospital and Health Sciences Center and
University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
3 Department of Radiology and Center for Imaging Science, Samsung Medical
Center, Sungkyunkwan University School of Medicine 50, Ilwon-Dong, Kangnam-Ku
Seoul 135-710, Korea.
4 Department of Pathology, Vancouver Hospital and Health Sciences Center and
University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
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Fig. 1. —Pulmonary edema due to fluid overload in 28-year-old woman
after hematopoietic stem cell transplantation. High-resolution CT scan
obtained though upper lobes shows smooth septal thickening in
gravity-dependent distribution. Left interlobar fissure is also prominent due
to subpleural edema.
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Fig. 2. —Engraftment syndrome in 46-year-old woman with non-Hodgkin's
lymphoma 3 weeks after allogeneic hematopoietic stem cell transplantation.
High-resolution CT scan shows bilateral areas of consolidation having
peribronchovascular and sub-pleural distribution. Note right pleural
effusion.
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Fig. 3A. —Diffuse alveolar hemorrhage in 46-year-old woman with
non-Hodgkin's lymphoma 3 weeks after allogeneic hematopoietic stem cell
transplantation. High-resolution CT scan obtained at level of carina shows
diffuse ground-glass opacity in addition to septal thickening (crazy
paving).
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Fig. 3B. —Diffuse alveolar hemorrhage in 46-year-old woman with
non-Hodgkin's lymphoma 3 weeks after allogeneic hematopoietic stem cell
transplantation. Photomicrograph of histopathologic specimen shows that
macrophages containing hemosiderin are present within alveolar spaces
(arrows). (H and E, x100)
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Fig. 4A. —Vincristine sulfate–induced interstitial pneumonitis in
63-year-old man with myeloma. High-resolution CT scan obtained at level of
carina shows diffuse ground-glass attenuation in right lung and bilateral
patchy areas of consolidation.
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Fig. 4B. —Vincristine sulfate–induced interstitial pneumonitis in
63-year-old man with myeloma. Photomicrograph of histopathologic section shows
patchy expansion of interstitium by lymphocytic infiltrate, mild interstitial
fibrosis, and reactive hyperplastic type 2 pneumocytes (arrows). (H
and E, x250)
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Fig. 5A. —Carmustine-induced diffuse alveolar damage in 63-year-old man
after allogeneic hematopoietic stem cell transplantation. High-resolution CT
scan obtained though lung bases shows diffuse ground-glass opacity involving
lower lung zones.
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Fig. 5B. —Carmustine-induced diffuse alveolar damage in 63-year-old man
after allogeneic hematopoietic stem cell transplantation. Photomicrograph of
histopathologic specimen shows diffuse alveolar thickening and expansion of
interstitium by mononuclear inflammatory cells, mild interstitial fibrosis,
and reactive hyperplastic type 2 pneumocytes. (H and E, x100)
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Fig. 6A. —Idiopathic pneumonia syndrome in 40-year-old man with acute
myelogenous leukemia 4 weeks after allogeneic hematopoietic stem cell
transplantation. High-resolution CT scan obtained at level of lower lung zones
shows bilateral patchy areas of consolidation and ground-glass
attenuation.
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Fig. 6B. —Idiopathic pneumonia syndrome in 40-year-old man with acute
myelogenous leukemia 4 weeks after allogeneic hematopoietic stem cell
transplantation. Photomicrograph of histopathologic specimen shows that
alveolar septa are thickened by edema and round cell infiltration
(arrow). Hyperplasia and desquamation of alveolar lining cells,
fibrinous exudation, and hyaline membranes (arrowheads) are seen
within alveolar spaces. (H and E, x250)
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Fig. 7. —Acute graft-versus-host disease in 34-year-old man with
cell-mediated lympholysis 5 weeks after hematopoietic stem cell
transplantation. High-resolution CT scan obtained at level of inferior
pulmonary veins shows small areas of consolidation (arrow) in
association with discrete right pleural effusion.
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Fig. 8. —Pleuropericardial effusion in 28-year-old woman after
hematopoietic stem cell transplantation. High-resolution CT scan with
mediastinal window setting shows presence of bilateral pleural and small
pericardial effusions.
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Fig. 9A. —Pulmonary cytolytic thrombi in 11-year-old boy after
hematopoietic stem cell transplantation for acute lymphoblastic leukemia. CT
scan shows discrete peripheral pulmonary nodules suggestive of opportunistic
infection (arrows).
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Fig. 9B. —Pulmonary cytolytic thrombi in 11-year-old boy after
hematopoietic stem cell transplantation for acute lymphoblastic leukemia.
Photomicrograph of histopathologic specimen shows that nodules consist
primarily of hemorrhagic infarcts (asterisk). Occlusive vascular
lesions are present within, adjacent to, and away from hemorrhagic infarct
(arrowheads). (H and E, x40)
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Fig. 9C. —Pulmonary cytolytic thrombi in 11-year-old boy after
hematopoietic stem cell transplantation for acute lymphoblastic leukemia.
Photomicrograph of histopathologic specimen shows that intensely basophilic,
tenacious, amorphous material occludes lumen of vessels (arrows). Few
intact cells recognized as leukocytes (arrowheads) are also seen
(inset). (H and E, x400) (Courtesy of Gulbahce HE, Minneapolis, MN)
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Fig. 10. —Acute radiation pneumonitis in 28-year-old woman after
hematopoietic stem cell transplantation. High-resolution CT scan shows
paramediastinal ground-glass attenuation with associated bronchovascular
distortion. Notice sharp border between radiated area and normal lung
parenchyma (arrows).
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Fig. 11A. —Chronic (obliterative) bronchiolitis in 48-year-old woman 5
months after allogeneic hematopoietic stem cell transplantation.
High-resolution CT scan obtained at level of lower lobes shows striking
dilatation of subsegmental airways in right lower lobe. General reduction in
lung parenchymal density is also noted.
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Fig. 11B. —Chronic (obliterative) bronchiolitis in 48-year-old woman 5
months after allogeneic hematopoietic stem cell transplantation.
Photomicrograph of histopathologic section of lung parenchyma shows moderately
severe mononuclear inflammatory cell infiltrate in peribronchiolar
interstitial tissue (arrows).
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Fig. 12A. —Organizing pneumonia after hematopoietic stem cell
transplantation in 38-year-old man. High-resolution CT scan obtained at level
of lower lung zones shows bilateral patchy areas of consolidation in
predominantly peribronchial distribution.
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Fig. 12B. —Organizing pneumonia after hematopoietic stem cell
transplantation in 38-year-old man. Photomicrograph of histopathologic
specimen shows presence of fibroblastic tissue in lumina of peribronchial
alveoli (arrows). (H and E, x100)
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Fig. 13. —Posttransplantation lymphoproliferative disease in
54-year-old man with multiple myeloma 2 months after allogenic hematopoietic
stem cell transplantation. CT scan shows multiple enlarged axillary and
mediastinal lymph nodes.
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Fig. 14A. —Radiation fibrosis in 48-year-old man after radiation therapy
for lymphoma. Chest radiograph obtained 1 year after radiation therapy shows
bilateral fibrotic changes in paramediastinal lung zone (arrows).
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Fig. 14B. —Radiation fibrosis in 48-year-old man after radiation therapy
for lymphoma. CT scan confirms bilateral paramediastinal fibrosis in
irradiation field (arrowheads).
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Fig. 15. —Mediastinal lymph node calcification in 38-year-old man after
radiation therapy for lymphoma. Close-up view of CT scan shows multiple
calcified retrosternal lymph nodes (arrows). Patient had undergone
radiation therapy for Hodgkin's disease 3 years previously.
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Fig. 16A. —Calcified thymic cyst in 30-year-old man after radiation
therapy for Hodgkin's disease. Posteroanterior (A) and lateral
(B) chest radiographs show anterior mediastinal mass with thin rim of
calcification (arrows).
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Fig. 16B. —Calcified thymic cyst in 30-year-old man after radiation
therapy for Hodgkin's disease. Posteroanterior (A) and lateral
(B) chest radiographs show anterior mediastinal mass with thin rim of
calcification (arrows).
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Fig. 16C. —Calcified thymic cyst in 30-year-old man after radiation
therapy for Hodgkin's disease. CT scan shows well-defined anterior mediastinal
mass with thin rim of calcification.
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Copyright © 2005 by the American Roentgen Ray Society.
