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Cytomegalovirus Pneumonia After Stem Cell Transplantation: Correlation of CT Findings with Clinical Outcome in 30 Patients

Marius S. Horger1, Christina Pfannenberg1, Hermann Einsele2, Robert Beck3, Holger Hebart2, Claudia Lengerke2, Reinhard Vonthein4, Manfred Wehrmann5, Christoph Faul2 and Claus Claussen1

1 Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, Tuebingen 72076, Germany.
2 Department of Hematology-Oncology, Eberhard-Karls-University, Tuebingen, Germany.
3 Institute of Medical Virology, Eberhard-Karls-University, Tuebingen, Germany.
4 Department of Medical Biometry, Eberhard-Karls-University, Tuebingen, Germany.
5 Department of Pathology, Eberhard-Karls-University, Tuebingen, Germany.


Figure 1
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  		Fig. 1 —44-year-old man with chronic myeloid leukemia after allogeneic transplantation. Thin-section high-resolution CT scan shows diffuse bilateral ground-glass opacity (arrow) sparing some lung segments. This CT finding was initial manifestation of pulmonary infection in this patient, progressing at follow-up to ground-glass opacity and air-space consolidation (not shown). Patient died 3 days after follow-up despite intensive antiviral therapy.

 

Figure 2
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  		Fig. 2 —42-year-old man with acute myeloid leukemia after allogeneic bone marrow transplantation. Thin-section high-resolution CT scan reveals scattered parenchymal small, mostly ill-defined centrilobular opacities. Lesions resolved at follow-up after antiviral therapy.

 

Figure 3
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  		Fig. 3 —Thin-section high-resolution CT scan in 56-year-old woman with acute myeloid leukemia shows small confluencing centrilobular nodule-like opacities (arrow) accompanied by fine reticulation. At follow-up, no progress of cytomegalovirus pneumonia was noted, but patient died later due to fulminant angioinvasive aspergillosis. Diagnosis was confirmed by autopsy.

 

Figure 4
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  		Fig. 4 —High-resolution CT scan in 45-year-old man with multiple myeloma after allogeneic transplantation initially shows patchy infiltrates consisting of ground-glass opacity and consolidation due to pulmonary cytomegalovirus infection. Patient died 14 days after imaging despite intensive antiviral therapy.

 

Figure 5
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  		Fig. 5 —55-year-old man with acute myelogenous leukemia. High-resolution CT scan shows focal consolidation in peribronchial distribution (arrow). Patient recovered after antiviral therapy.

 

Figure 6
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  		Fig. 6 —57-year-old man with acute myelogenous leukemia after allogeneic peripheral blood stem cell transplantation. High-resolution CT scan shows lobular ground-glass opacities and delineation of secondary lung lobules due to lymphedema (arrow). At follow-up (not shown), diffuse opacity of both lungs was seen, suggesting diffuse alveolar damage. Patient died 4 weeks after follow-up despite sustained antiviral therapy.

 

Figure 7
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  		Fig. 7 —34-year-old woman with acute lymphoblastic leukemia after allogeneic bone marrow transplantation. High-resolution CT scan reveals coexisting focal bilateral zones of ground-glass opacity (white arrow) or consolidation (black arrow).

 

Figure 8
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  		Fig. 8A —60-year-old man with acute myelogenous leukemia after induction therapy. During bone marrow regeneration, small ill-defined centrilobular opacities (arrow) were seen in both lungs on CT. At that time, cytomegalovirus pneumonia (CMV) reactivation was documented. After antiviral therapy, centrilobular opacities resolved almost completely.

 

Figure 9
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  		Fig. 8B —60-year-old man with acute myelogenous leukemia after induction therapy. Two weeks after A, despite sustained antiviral therapy, patient again developed symptoms of pulmonary infection. At that time, new CT pattern of pulmonary infection consisting of patchy ground-glass opacity and septal edema was seen.

 

Figure 10
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  		Fig. 8C —60-year-old man with acute myelogenous leukemia after induction therapy. Three days after B, CT scan shows ground-glass opacity and air-space consolidation, suggesting diffuse alveolar damage. Patient died of CMV pneumonia a few days later despite intensive antiviral therapy.

 

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