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Gastrointestinal Imaging |
1 From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110. Received December 9, 1998; revision requested January 14, 1999; revision received January 28; accepted April 30. Address reprint requests to M.J.S. (e-mail: siegelm@mirlink.wustl.edu).
PURPOSE: To study the appearance and distribution of posttransplantation lymphoproliferative disorder (PTLD) at abdominal computed tomography (CT).
MATERIALS AND METHODS: The authors retrospectively analyzed pretreatment abdominal CT scans in 51 patients (mean age, 36 years) with PTLD after solid organ transplantation. All diagnoses were proved at either abdominal (n = 26) or extraabdominal (n = 25) pathologic examination. Presence or absence of abdominal involvement, appearance and distribution of disease, and association with abdominal symptoms were all analyzed.
RESULTS: CT scans were abnormal in 36 of the 51 patients (71%). Fifteen patients (29%) had no CT, clinical, or pathologic evidence of abdominal involvement. Of the 36 patients with abdominal PTLD at CT, 22% had lymph node enlargement, 28% splenic involvement, and 81% extranodal or extrasplenic involvement. Extranodal abdominal sites included liver (53%), small bowel (25%), kidney (17%), mesentery (14%), adrenal gland (8%), abdominal wall (8%), colon (6%), stomach (3%), and gallbladder (3%). Frequency of abdominal involvement was greater for heart and liver transplant recipients (94%) than for lung and kidney transplant recipients (58%) (P < .01). Seventeen of 36 patients (47%) with abdominal PTLD had no evidence of extraabdominal disease.
CONCLUSION: Extranodal involvement is more common than splenic or nodal involvement in patients with abdominal PTLD. The presence of such findings in a patient after transplantation strongly suggests the diagnosis of PTLD and warrants aggressive evaluation.
Index terms: Heart, transplantation, 51.459 • Kidney, transplantation, 81.455 • Liver, transplantation, 761.459 • Lung, transplantation, 60.459 • Lymphoma, 60.1211, 70.1211 • Transplantation
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