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Weekly Chest CasesArchive of Old Cases

Case No : 617 Date 2009-08-23

  • Courtesy of Jin-Hwan Kim / Chungnam National University, School of Medicine, University Hospital
  • Age/Sex 16 / F
  • Chief ComplaintAML patient, Dyspnea
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Diagnosis With Brief Discussion

Diagnosis
Bronchiolitis obliterance in patient with Graft Versus Host disease after bone marrow transplantation.
Radiologic Findings
Chest radiograph showed no abnormal finding.

Initial CT images showed mosaic attenuation in both lung, suggesting small air way obstruction. Small amount of pneumomediastinum was also noted. The pneumomediastinum was increased in amount and mosaic attenuation in the both lung parenchyma was noted on CT after 1 month. On last follow-up CT scan, the pneumomediastinum was disappeared, but bronchiectasis was newly noted.
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. Conventional chest radiographs may be normal. CT findings that have been described include bronchial dilatation, air-trapping on expiratory scans, and a mosaic attenuation pattern. The low attenuation of lobules affected by constrictive bronchiolitis reflects hypoxic vasoconstriction that results from impaired ventilation.
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
Keywords
Airway, Lung, Airway disease including COPD, Bronchiolitis, bone marrow transplantation,

No. of Applicants : 76

▶ Correct Answer : 12/76,  15.8%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Osaka University , Japan Osamu Honda
  • - hospital Sao Paulo , Brazil israel missrie
  • - IRCCS Istituto Oncologico Bari , Italy Carlo Florio
  • - CHRU Lille , France Benjamin Damarey
  • - SMC , Korea (South) Jihoon Cha
  • - Saga University , Japan Ryoko Egashira
  • - Seoul St Mary , Korea (South) Jin Kyoung Oh
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - Asan Medical Center , Korea (South) Seong Yun Kim
▶ Correct Answer as Differential Diagnosis : 5/76,  6.6%
  • - McGill University Health Centre , Canada Amr Ajlan
  • - Seoul Nationial University Bundang Hospital , Korea (South) Kyoung Jin Oh
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - IRSA La Rochelle France , France Denis Chabassiere
▶ Semi-Correct Answer : 12/76,  15.8%
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - Pneumology GHSR , Reunion fabrice paganin
  • - CHU caen , France nicolas gautier
  • - Samsung Medical Center , Korea (South) Ju Won Lee
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Hital du SacrCoeur, Montrl , Canada Andrea Ojanguren
  • - IRSA , France jean-Luc BIGOT
  • - NASA SCANS , India RAKESH BHATIA
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - PITTWATER RADIOLOGY , Australia Julie Arora
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