대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1179 Date 2020-05-28

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  • Courtesy of Hwayoung Song, Junghoon Kim, Jihang Kim, Kyung Hee Lee, Kyung Won Lee / Seoul National University Bundang Hospital
  • Age/Sex 36 / F
  • Chief ComplaintFever (for 2 days) / PHx: lung transplantation (4 months ago)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
CMV (cytomegalovirus) pneumonia
Radiologic Findings
Fig 1. Chest PA shows suspicious diffuse increased opacity in both lower lung zone.
Fig 2. CT scan reveals diffuse ill-defined centrilobular nodules in both lungs with lower lobe predominance.
Fig 3-4. Two weeks later, previsouly noted ill-defined centrilobular nodules and GGO are increased in extent in both lungs.

Brief Review
Lung-transplanted patients are at particular risk of allograft infections and radiologists should be aware of the epidemiology of pneumonias according to their time of onset.
The first postoperative month is mostly associated with bacterial and fungal pathogens. Bacterial infections are the most common. CT signs of bacterial infections include extensive consolidations with air bronchogram, disseminated patchy consolidations, branching centrilobular nodules, and cavitations or abscesses. CT signs of angioinvasive aspergillosis are isolated or multiple vessel centered nodular consolidations with peripheral ground-glass halo sign consistent with hemorrhagic infarcts.
From the second to sixth months, long-term immunosuppression of T-cells is responsible for viral pneumonias. CT signs mainly consist of ground-glass opacities or tree-in-bud nodules. Fungal and parasitic opportunistic infections can also occur, either from reactivation of latent germs, in particular from cytomegalovirus (CMV), or by community-acquired or nosocomial transmission. CT signs for such diseases also include ground-glass opacities, tree-in-bud nodules, or an interstitial pattern with peribronchovascular and septal thickening.
Cytomegalovirus (CMV) is the most common cause of opportunistic infection. The rate of CMV infection in lung transplant recipients has been reported to be at least 50%. Seronegative recipients who receive seropositive donor lungs are at the highest risk for primary infection after transplantation. CMV infection typically occurs between 1 and 6 months and is rarely seen earlier than 2 weeks after lung transplantation. Pneumonia is the most common manifestation of CMV infection. Frequently seen radiographic patterns include focal or diffuse parenchymal haziness, lobar consolidation, and small pleural effusions. The most common CT manifestations include ground-glass opacities, tree-in-bud opacities, airspace consolidation, nodules, interlobular septal thickening, pleural effusions, thickened and enhancing pleura, and bronchiectasis.
Please refer to
Case 73, Case 143, Case 249, Case 436,
KSTR Symposium 1998  Case 4,
References
1. Krishnam, M.S., Suh, R.D., Tomasian, A. et al, Postoperative complications of lung transplantation: radiologic findings along a time continuum. Radiographics. 2007;27:957
Keywords
lung, viral infection, cytomegalovirus (CMV) Pneumonia,

No. of Applicants : 80

▶ Correct Answer : 45/80,  56.3%
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Jiangsu province hospital , China WANGJIAN ZHA
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - , Korea (South) JIN YOUNG LEE
  • - Chonbuk National University Hospital , Korea (South) HYEJIN YANG
  • - , Korea (South) HYUNGYU LEE
  • - University of Tsukuba Hospital , Japan HIROAKI TAKAHASHI
  • - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
  • - Other , Korea (South) MINSU KIM
  • - Chonnam National University Hospital , Korea (South) MOON GYEONG IL
  • - , India SUSHANT JOSHI
  • - , Japan YASUSHI AOYAGI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Seoul Veterans Hospital , Korea (South) JI HOON NOH
  • - Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG
  • - , Japan YUMI MAEHARA
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Pusan National University Yangsan Hospital , Korea (South) JI HWAN KIM
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Chonbuk National University Hospital , Korea (South) SOL KI KIM
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - radiologist, aditya imaging centre , India VIVEK PATEL
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Korea (South) HYEYOUNG CHOI
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - iran university , Iran MOHAMAD REZA AYOUBPOUR
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Private sector , Greece VASILIOS TZILAS
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Hamamatsu University Hospital , Japan HAYATO NOZAWA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - CH de la Cote Basque , France PAUL ARDILOUZE
▶ Correct Answer as Differential Diagnosis : 19/80,  23.8%
  • - Kitano Hospital , Japan SATOSHI IKEDA
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - Chonnam National University Hospital , Korea (South) SEUNGYOON CHAE
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Samsung Medical Center , Korea (South) CHOHEE KIM
  • - , Korea (South) CHOI SOOYOUNG
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - The University of Tokyo Hospital , Japan MOTO NAKAYA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - TB centre kasaragod. , India rikhy krishnan
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - , Japan KAZUMA TERAUCHI
  • - , Korea (South) CHAEHUN LIM
  • - , Japan HIROAKI ARAKAWA
▶ Semi-Correct Answer : 2/80,  2.5%
  • - Holy Family Hopsital , India RAJESH GOTHI
  • - , Korea (South) SUNGEUN YUN
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