대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Lung Graft-versus-Host Disease (GVHD)

Radiologic Findings

Chest radiography show bilateral diffuse reticular and patchy opacities in both lungs. Initial HRCT demonstrate randomly distributed multiple areas of ground glass attenuation in both lungs. Follow up HRCT, 9months later, after steroid therapy show newly appeared diffuse hypoattenuation and bronchiectasis without bronchial wall thickening. Previously noted ground glass attenuation is decreased in extent in both lungs in association with hyperinflation.

Brief Review

Within the spectrum of pulmonary disorders classified as post-transplantation, late-onset, noninfectious pulmonary complications(LONIPC) have been defined and include bronchiolitis obliterans (BO), bronchiolitis obliterans with organizing pneumonia (BOOP), diffuse alveolar damage (DAD), lymphocytic interstitial pneumonia (LIP), and nonspecific interstitial pneumonia (NSIP). Among them,the prevalence of BO after transplantation has been reported by different centers to between 1,2 and 11% for BMT. The most common abnormality on chest radiography of GVHD is bilateral diffuse or patchy infiltrates, which is a nonspecific finding. At diagnosis of BO, it has usually normal chest radiographs. The commonest HRCT abnormalities of BO consists of patchy areas of decreased parenchymal attenuation, subsegmental and segmental bronchial dilatation and centrilobular branching structures. Bronchial wall thickening is not a prominent feature. The CT findings in the remaining diseases of GVHD include ground-glass opacities with or without architectural distortions, traction bronchiectasis, and regions of consolidation. Previous study found a link between bronchial dilatation and BO, and concluded that evidence of bronchial dilatation by HRCT was more sensitive in predicting the presence of BO than were chest radiographs or transbronchial biopsy.
The excellent treatment outcome in patients with BOOP and in those with mild respiratory functional impairment with enhanced immunosuppression was reported. NSIP represents a heterogenous group of pulmonary process, suggested by the variable intragroup treatment outcome. In contrast, the inferior prognosis in BO is commensurate with the hypothesis that BO represents end-stage irreversible lung damage.

References

1.Palmas A, Tefferi A, Myers JL, Scott JP, Swensen SJ, Chen MG, Gastineau DA, Gertz MA, Inwards DJ, Lacy MQ, Litzow MR. Late-onset noninfectious pulmonary complications after allogeneic bone marrow transplantation. Br J Haematol. 1998 Mar;100(4):680-7
2. Padley SP, Adler BD, Hansell DM, Muller NL. Bronchiolitis obliterans: high resolution CT findings and correlation with pulmonary function tests. Clin Radiol. 1993 Apr;47(4):236-40
3. Sargent MA, Cairns RA, Murdoch MJ, Nadel HR, Wensley D, Schultz KR. Obstructive lung disease in children after allogeneic bone marrow transplantation: evaluation with high-resolution CT. AJR Am J Roentgenol. 1995 Mar;164(3):693-6.
4. Worthy SA, Flint JD, Muller NL. Pulmonary complications after bone marrow transplantation: high-resolution CT and pathologic findings. Radiographics. 1997 Nov-Dec;17(6):1359-71.

Keywords

Lung, Iatrogenic lung disease,