대한흉부영상의학회 Korean Society of Thoracic Radiology

대한흉부영상의학회 Weekly Case 메뉴

Close

대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
Advanced Search..

Close

Weekly Chest CasesArchive of Old Cases

Case No : 1179 Date 2020-05-28

  • 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;27:957–974.
2. Habre C, Soccal PM, Triponez F et al (2018) Radiological findings of complications after lung transplantation. Insights Imaging 9(5):709–719.
Keywords
lung, viral infection, cytomegalovirus (CMV) Pneumonia,

No. of Applicants : 80

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

Each Case of This Site Supplied by the Members of KSTR.
Copyright of the Images is in the KSTR and Original Supplier.
Current Editor : Eui Jin Hwang, M.D., Ph.D Email : weeklychestcases@gmail.com

This website is optimized for IE 10 and above.