In: Bronchiolitis28 Mar 2014
Detection Using Expiratory HRCT
Bronchiolitis obliterans (BO) is the major longterm complication after heart-lung and lung transplantation occurring in up to 50% of transplant recipients. Widely presumed but unproved to be a manifestation of chronic rejection, the pathologic lesion of BO appears to be a chronic inflammatory and fibroproliferative process centered on the terminal and respiratory bronchioles leading to airway distortion and scarring.2 Clinically, BO is characterized by progressive airway obstruction that may eventually result in death or retransplantation. Early detection and initiation of directed immunosuppressive therapy may be important for stabilization of lung function.
On high-resolution CT (HRCT), bronchiectasis has been reported as a frequent though often late finding in lung transplant recipients with BO. A mosaic pattern of lung attenuation, also described as an associated finding, is believed to result from regional airway obstruction. Based on recent literature demonstrating the utility of expiratory images in the evaluation of small airway diseases, we undertook this study to determine if air trapping, as detected on expiratory HRCT, is a useful indicator of BO in the lung transplant population.
Materials and Methods
Nineteen heart-lung and two bilateral, sequential lung transplant recipients were recruited into this study during regularly scheduled follow-up visits. The 11 patients with previous trans-bronchial biopsy specimen-proved BO consisted of 9 women and 2 men with a group mean age of 44 years (range, 24 to 53 years). Their mean time from transplantation was 4.8 years (range, 0.7 to 6.2 years); their mean duration of known BO was 1.3 years (range, 1 day to 3.2 years). Five patients had BO diagnosed within 6 months of time of study assessment. Preoperative indications for transplantation were as follows: primary pulmonary hypertension (n=3); Eisenmenger’s syndrome (n=3); ax-antitrypsin deficiency (n=2); cystic fibrosis (n=2); and bronchiectasis (n=l).
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