|Patient: 18 year old|
|History: Woman with cystic fibrosis, status post bilateral lung transplantation approximately three years ago.|
Radiopharmaceutical: 14.8 mCi Xe-133 gas by inhalation and 4.1 mCi Tc-99m MAA i.v.
High-resolution CT images (Fig. 3) demonstrate diffuse mosaic attenuation in the upper lung zones predominantly and diffuse areas of air trapping bilaterally. There has been interval development of bronchiectasis bilaterally, involving the upper and lower lobes.
|Diagnosis: Bronchiolitis obliterans (chronic rejection)|
General Discussion: Full patient history: |
18-year-old woman status post bilateral lung transplantation 3 years previously, presenting with worsening pulmonary function. The patient had developed post-transplant lymphproliferative disorder approximately 9 months earlier and as a result was on decreased doses of immunosuppressive medications.
The imaging and clinical findings were thought to be most consistent with bronchiolitis obliterans (chronic rejection). The patient underwent transbronchial lung biopsy, which showed minimal acute cellular rejection superimposed on chronic airway rejection. The patient subsequently underwent repeat bilateral lung transplantation. A followup ventilation-perfusion scan several months after the transplantation was normal (Fig. 4).
Bronchiolitis obliterans (obliterative bronchiolitis) may affect up to 50% of lung transplant patients. It can be difficult to diagnosis on transbronchial biopsy, and the diagnosis may be suggested by an otherwise unexplained decline in lung function. A typical finding on expiratory high-resolution CT images is air trapping, corresponding to the xenon retention seen on washout ventilation images.
|References: Li Ng Y, et al, "Imaging of Lung Transplantation: Review," AJR 2009; 192(3):S1-S13.|
Hasegawa Y, "Perfusion and ventilation isotope lung scans in constrictive bronchiolitis obliterans. A series of three cases," Respiration 2002; 69(6):550-5.
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Case Number: 174166Owner(s): Joanna Fair and Keith FischerLast Updated: 12-15-2010 The reader is fully responsible for confirming the accuracy of this content.
The reader is fully responsible for confirming the accuracy of this content.