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Weekly Chest CasesArchive of Old Cases

Case No : 709 Date 2011-05-31

  • Courtesy of Sang Hyun Paik / Soonchunhyang University Bucheon Hospital, Korea.
  • Age/Sex 20 / F
  • Chief ComplaintLeukemic patient without pulmonary symptom.
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Bronchiolitis obliterans associated with bone marrow transplantation
Radiologic Findings
Chest radiograph showed no abnormal finding except focal increased opacity in RML.
CT images showed mosaic attenuation in both lung, suggesting small air way obstruction. Expiratory CT scans showed more prominent mosaic attenuation in both lungs.
Brief Review
Pulmonary complications occur in 40%-60% of stem cell transplant recipients and considerably influence morbidity and mortality. Risk factors for the development of pulmonary complications following transplantation include pre-transplantation chemotherapy, duration of immune system dysfunction, type of transplant, and presence of GVHD.
Constrictive bronchiolitis occurs in 10% of allogenic transplant recipients. Histologic analysis reveals progressive concentric fibrosis that obstructs bronchioles. Patients present with dyspnea, nonproductive cough, and pulmonary function abnormalities; fever is unusual. As the disease progresses, airflow deteriorates and dyspnea worsens. The mortality rate is 61%, and there is no effective treatment.
In the absence of infecion, radiographs are typically normal or show only mild hyperinflation, similar to changes identified in other conditions associated with constrictive bronchiolitis. HRCT shows typical findings of BO, with evidence of bronchiectasis, mosaic peribronchiolar, air trapping. In an early stage, ill-defined peribronchiolar, centrilobular opacities have been identified. In a study by Ooi et al., HRCT was performed in nine patients who had moderately severe irreversible airflow obstruction and a clinical diagnosis of BOS (persistent lung function deterioration, with FEV1 of less than 80% of baseline values) after BMT. Two patients had normal HRCT scans. In the remaining 7 patients, 7 of 11 HRCT scans were abnormal, with nonspecific findings of bronchial dilatation (one patient), consolidation (two patients), areas of decreased opacity (four patients), and vascular attenuation (four patients).
References
1. David L. Coy, Amaya Ormazabal, J. David Godwin, et al. Imaging Evaluation of Pulmonary and Abdominal Complications Following Hematopoietic Stem Cell Transplantation. RadioGraphics 2005;25:305-317
2. Gruden JF, Webb WR. Identification and evaluation of centrilobular opacities on high-resolution CT. Semin Ultrasound CT MRI 1995;16:435-449
3. Ooi GC, Peh WC, Ip M. High-resolution computed tomography of bronchiolitis obliterans syndrome after bone marrow transplantation. Respiration 1998;65:187-191
Keywords
airway, airway disease,

No. of Applicants : 106

▶ Correct Answer : 53/106,  50.0%
  • - Okayama University , Japan Akihiro Tada
  • - University of British Columbia , Canada Amr Ajlan
  • - Severance hospital , Korea (South) Saerom Hong
  • - Chuncheon Sacred Heart Hospital , Korea (South) Kyung bum Nam
  • - Japanese Red Cross Society Himeji Hospital , Japan Yuichiro Kanie
  • - Hopital cardiologique Louis Pradel LYON , France ROUSSET matthieu
  • - Iwate Medical University , Japan Akio Akahane
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Soon Chun Hyang, Seoul , Korea (South) Yoo Na Kim
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae Wook Yeh
  • - Saga University , Japan Ryoko Egashira
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
  • - DCA, , India Rajesh Gothi
  • - Chung-Nam National University Hospital , Korea (South) KI-TAE HAN
  • - Saint Malo , France jean-baptiste Noel
  • - Chaeil Clinic , Korea (South) Sunkyung Lim
  • - HSC , Brazil Diogo Pinheiro
  • - Chungnam National University hospital , Korea (South) sunkyoung you
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - Az Osp Santa Maria Terni , Italy angelo carloni
  • - McGill University Health Center , Canada Alexandre Semionov
  • - yeong gwang general hospital , Korea (South) Mokhee Kim
  • - radiologist, aditya imaging centre , India vivek patel
  • - Armed Forces Yangju Hospital , Korea (South) Ho-Joon Lee
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Yonsei university Shinchon Severance hospital , Korea (South) Na-young Shin
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Severance hospital , Korea (South) Beomseok Sohn
  • - Seoul St Mary Hospital , Korea (South) Chaehun Lim
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - 紐…吏€蹂‘ , Korea (South) Yongsuk Jang
  • - Hanyang university medical center , Korea (South) YOONAH SONG
  • - Kyungpook university hospital , Korea (South) So mi Lee
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Himeji Red Cross Hospital , Japan ryota inai
  • - Mallinckrodt Institute of Radiology , United States Travis Henry
  • - Kizawa memorial Hospital , Japan Yo Kaneko
  • - Teleradiology , India Savith Kumar
  • - snuh , Korea (South) Choo jiyung
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - University of Rochester Medical Center , United States Hongju Son
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - St-Luc Bruxelles , Belgium Tancredi Illario
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - A.P.Chest hospital , India k bhaskar
  • - Chonnam national univ. hospital , Korea (South) Choi Seul Gi
  • - All India Institute of medical sciences , India Justin Moses
▶ Correct Answer as Differential Diagnosis : 7/106,  6.6%
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Istanbul , Turkey Armagan Sarac
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - CHRU lille , France manuel toledano
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
▶ Semi-Correct Answer : 3/106,  2.8%
  • - Ospedale di Forl� , Italy Edoardo Cavigli
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
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