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Bronchiolitis obliterans after allogenic bone marrow transplantation: HRCT findings.

Jung JI, Jung WS, Hahn ST, Min CK, Kim CC, Park SH - Korean J Radiol (2004 Apr-Jun)

Bottom Line: Expiratory air trapping was noted in all patients.HRCT scans are abnormal in patients with BO, with the most commonly observed finding being areas of decreased lung attenuation.While the HRCT findings are not specific, it is believed that their common features can assist in the diagnosis of BO in BMT recipients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. jijung@catholic.ac.kr

ABSTRACT

Objective: To evaluate the high resolution computed tomography (HRCT) findings of bronchiolitis obliterans (BO) after bone marrow transplantation (BMT).

Materials and methods: During the past three years, 11 patients were diagnosed as having BO after BMT when they developed irreversible air flow obstruction, with an FEV(1) value of less than 80% of the baseline value, without any clinical evidence of infection. All 11 patients underwent HRCT, of whom eight also underwent follow-up HRCT. The HRCT images were assessed retrospectively for the presence of decreased lung attenuation, segmental or subsegmental bronchial dilatation, diminution of peripheral vascularity, centrilobular nodules, and branching linear structure on the inspiratory images. The lobar distribution of the decreased lung attenuation and bronchial dilatation was also examined. The presence of air trapping was investigated on the expiratory images. The interval changes of the HRCT findings were evaluated in those patients who had followup images.

Results: Abnormal HRCT findings were present in all cases; the most common abnormalities were decreased lung attenuation (n=11), subsegmental bronchial dilatation (n=6), diminution of peripheral vascularity (n=6), centrilobular nodules or branching linear structure (n=3), and segmental bronchial dilatation (n=3). Expiratory air trapping was noted in all patients. The decreased lung attenuation and bronchial dilatations were more frequent or extensive in the lower lobes. Interval changes were found in all patients with follow-up HRCT: increased extent of decreased lung attenuation (n=7); newly developed or progressed bronchial dilatation (n=4); and increased lung volume (n=3).

Conclusion: HRCT scans are abnormal in patients with BO, with the most commonly observed finding being areas of decreased lung attenuation. While the HRCT findings are not specific, it is believed that their common features can assist in the diagnosis of BO in BMT recipients.

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Related in: MedlinePlus

Progression of bronchiolitis obliterans on high resolution computed tomography in a 28-year-old woman. Bronchiolitis obliterans was diagnosed on spirometry and transbronchial lung biopsy 16 months after bone marrow transplantation for chronic myelocytic leukemia.A. Inspiratory high resolution computed tomography scan at the time of diagnosis of bronchiolitis obliterans shows small areas of decreased lung attenuation in both upper lobes (arrows).B. Inspiratory high resolution computed tomography scan taken nine months later at a similar anatomic level to A, shows markedly increased extent of pulmonary hypoattenuation and new development of subsegmental bronchial dilatations. The lung volume is much increased.
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Figure 4: Progression of bronchiolitis obliterans on high resolution computed tomography in a 28-year-old woman. Bronchiolitis obliterans was diagnosed on spirometry and transbronchial lung biopsy 16 months after bone marrow transplantation for chronic myelocytic leukemia.A. Inspiratory high resolution computed tomography scan at the time of diagnosis of bronchiolitis obliterans shows small areas of decreased lung attenuation in both upper lobes (arrows).B. Inspiratory high resolution computed tomography scan taken nine months later at a similar anatomic level to A, shows markedly increased extent of pulmonary hypoattenuation and new development of subsegmental bronchial dilatations. The lung volume is much increased.

Mentions: Interval changes were found in all eight patients who underwent follow-up HRCT scans. These changes consisted of an increased extent of decreased lung attenuation (n=7), newly developed or progressive bronchial dilatation (n=4), increased lung volume (n=2), bronchial wall thickening and centrilobular nodules (n=1), and diminished vascularity (n=1) (Fig. 4).


Bronchiolitis obliterans after allogenic bone marrow transplantation: HRCT findings.

Jung JI, Jung WS, Hahn ST, Min CK, Kim CC, Park SH - Korean J Radiol (2004 Apr-Jun)

Progression of bronchiolitis obliterans on high resolution computed tomography in a 28-year-old woman. Bronchiolitis obliterans was diagnosed on spirometry and transbronchial lung biopsy 16 months after bone marrow transplantation for chronic myelocytic leukemia.A. Inspiratory high resolution computed tomography scan at the time of diagnosis of bronchiolitis obliterans shows small areas of decreased lung attenuation in both upper lobes (arrows).B. Inspiratory high resolution computed tomography scan taken nine months later at a similar anatomic level to A, shows markedly increased extent of pulmonary hypoattenuation and new development of subsegmental bronchial dilatations. The lung volume is much increased.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698138&req=5

Figure 4: Progression of bronchiolitis obliterans on high resolution computed tomography in a 28-year-old woman. Bronchiolitis obliterans was diagnosed on spirometry and transbronchial lung biopsy 16 months after bone marrow transplantation for chronic myelocytic leukemia.A. Inspiratory high resolution computed tomography scan at the time of diagnosis of bronchiolitis obliterans shows small areas of decreased lung attenuation in both upper lobes (arrows).B. Inspiratory high resolution computed tomography scan taken nine months later at a similar anatomic level to A, shows markedly increased extent of pulmonary hypoattenuation and new development of subsegmental bronchial dilatations. The lung volume is much increased.
Mentions: Interval changes were found in all eight patients who underwent follow-up HRCT scans. These changes consisted of an increased extent of decreased lung attenuation (n=7), newly developed or progressive bronchial dilatation (n=4), increased lung volume (n=2), bronchial wall thickening and centrilobular nodules (n=1), and diminished vascularity (n=1) (Fig. 4).

Bottom Line: Expiratory air trapping was noted in all patients.HRCT scans are abnormal in patients with BO, with the most commonly observed finding being areas of decreased lung attenuation.While the HRCT findings are not specific, it is believed that their common features can assist in the diagnosis of BO in BMT recipients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. jijung@catholic.ac.kr

ABSTRACT

Objective: To evaluate the high resolution computed tomography (HRCT) findings of bronchiolitis obliterans (BO) after bone marrow transplantation (BMT).

Materials and methods: During the past three years, 11 patients were diagnosed as having BO after BMT when they developed irreversible air flow obstruction, with an FEV(1) value of less than 80% of the baseline value, without any clinical evidence of infection. All 11 patients underwent HRCT, of whom eight also underwent follow-up HRCT. The HRCT images were assessed retrospectively for the presence of decreased lung attenuation, segmental or subsegmental bronchial dilatation, diminution of peripheral vascularity, centrilobular nodules, and branching linear structure on the inspiratory images. The lobar distribution of the decreased lung attenuation and bronchial dilatation was also examined. The presence of air trapping was investigated on the expiratory images. The interval changes of the HRCT findings were evaluated in those patients who had followup images.

Results: Abnormal HRCT findings were present in all cases; the most common abnormalities were decreased lung attenuation (n=11), subsegmental bronchial dilatation (n=6), diminution of peripheral vascularity (n=6), centrilobular nodules or branching linear structure (n=3), and segmental bronchial dilatation (n=3). Expiratory air trapping was noted in all patients. The decreased lung attenuation and bronchial dilatations were more frequent or extensive in the lower lobes. Interval changes were found in all patients with follow-up HRCT: increased extent of decreased lung attenuation (n=7); newly developed or progressed bronchial dilatation (n=4); and increased lung volume (n=3).

Conclusion: HRCT scans are abnormal in patients with BO, with the most commonly observed finding being areas of decreased lung attenuation. While the HRCT findings are not specific, it is believed that their common features can assist in the diagnosis of BO in BMT recipients.

Show MeSH
Related in: MedlinePlus