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Published online before print February 1, 2002, 10.1148/radiol.2223010456
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(Radiology 2002;222:699-708.)
© RSNA, 2002

Pediatric Imaging

Posttransplantation Lymphoproliferative Disorder: Manifestations in Pediatric Thoracic Organ Recipients1

Gye Yeon Lim, MD2, Beverley Newman, MD, Geoffrey Kurland, MD and Steven Alan Webber, MD

1 From the Departments of Radiology (G.Y.L., B.N.) and Pediatrics (G.K., S.A.W.), Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 3705 Fifth Ave at DeSoto St, Pittsburgh, PA 15213-2583. Received February 13, 2001; revision requested March 20; revision received July 3; accepted July 26. Address correspondence to B.N. (e-mail: newmanb@chplink.chp.edu).

PURPOSE: To describe and correlate the clinical and imaging features of posttransplantation lymphoproliferative disorder (PTLD) in young thoracic organ transplant recipients.

MATERIALS AND METHODS: The authors retrospectively reviewed the medical and imaging records of 31 PTLD episodes in 27 patients with PTLD out of 183 young patients who survived for at least 1 month after thoracic organ transplantation: 18 (14%) heart transplant recipients and nine (16%) lung or heart-lung transplant recipients. Four patients had two separate PTLD episodes. The distribution, timing, and imaging features of the disease were analyzed.

RESULTS: Seventeen (55%) of 31 episodes involved intrathoracic PTLD manifesting as multiple pulmonary nodules (n = 10), a solitary nodule (n = 3), alveolar consolidation (n = 3), and/or mediastinal adenopathy (n = 8). Extrathoracic PTLD occurred in 21 (68%) of 31 episodes and involved the abdomen (n = 15), head and neck (n = 11), and/or central nervous system (n = 3). The imaging findings of these episodes included bowel wall thickening, lymphadenopathy, and focal masses. Intrathoracic PTLD occurred more commonly in lung transplant recipients (89%) than in heart transplant recipients (44%); no cases of lymphoma involved the thorax. The frequency of extrathoracic manifestations was higher in heart transplant recipients (83%) than in lung transplant recipients (33%). In lung transplant recipients, the prevalence of early-onset PTLD was significantly greater than that in heart transplant recipients (P < .05). Intrathoracic PTLD tended to manifest early.

CONCLUSION: PTLD in young thoracic transplant recipients involves the lungs and extrathoracic organs, tends to have an early onset, and manifests predominantly in the thorax in lung transplant and heart-lung transplant recipients, as opposed to heart transplant recipients.

© RSNA, 2002

Index terms: Heart, CT, 51.12111, 51.12112 • Heart, transplantation, 51.45 • Hodgkin disease, 60.34 • Lung, CT, 60.12111, 60.12112 • Lung, transplantation, 60.45 • Lymphatic system, diseases, 60.342, 60.343




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