Complications (Excluding Hyperinflation) Involving the Native Lung after Single-Lung Transplantation: Incidence, Radiologic Features, and Clinical Importance1
H. Page McAdams, MD,
Jeremy J. Erasmus, MD and
Scott M. Palmer, MD
1 From the Departments of Radiology (H.P.M., J.J.E.) and Medicine, Division of Pulmonary and Critical Care Medicine (S.M.P.), Duke University Medical Center, Box 3808, Durham, NC 27710. Received February 22, 2000; revision requested April 7; revision received May 17; accepted June 1. Address correspondence to H.P.M. (e-mail: mcada003@mc.duke.edu).
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Figure 1. Patient 1. P aeruginosa pneumonia in a 60-year-old man with cough, fever, and dyspnea at presentation 26 months after right single-lung transplantation for emphysema. Transverse chest CT scan (10-mm collimation, lung window) shows severe emphysema in the native left lung and peripheral homogeneous opacity in the left lower lobe (arrows). Peribronchial opacities in the right lower lobe were unchanged from those seen at CT 2 months previously. Cultures of bronchoalveolar lavage fluid from the left lower lobe grew P aeruginosa bacteria. The patient subsequently died of respiratory failure.
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Figure 2. Patient 5. Tuberculosis in a 60-year-old man with cough, fever, and dyspnea at presentation 10 months after left single-lung transplantation for rheumatoid lung disease. Posteroanterior chest radiograph shows new heterogeneous opacities (arrows) in the native right lower lobe. Bilateral pleural thickening was unchanged from that seen on multiple prior radiographs. Cultures of bronchoalveolar lavage fluid from the right lower lobe were positive for M tuberculosis infection. The patient subsequently died of respiratory failure.
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Figure 3. Patient 6. Atypical mycobacterial infection in an asymptomatic 62-year-old woman with new radiographic abnormalities 16 months after right single-lung transplantation for emphysema. Transverse chest CT scan (10-mm collimation, lung window) shows severe emphysema in the native left lung and two small nodules in the left upper lobe (arrow). Resected thoracoscopic wedge specimen revealed granulomatous inflammation with numerous acid-fast bacilli. Cultures grew M avium-intracellulare complex.
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Figure 4a. Patient 10. Rhizopus species infection in a 53-year-old woman with cough, fever, and chest pain at presentation 2 months after right single-lung transplantation for emphysema. (a) Posteroanterior chest radiograph shows cavitary mass in the native left lower lobe (arrows). Opacities in the right lung (allograft) were unchanged from those seen on multiple prior radiographs. (b) Transverse chest CT scan (10-mm collimation, lung window) confirms a cavitary mass and an intracavitary mass (M) in the left lower lobe and shows the air crescent sign (arrow). CT-guided aspiration biopsy demonstrated Rhizopus species infection that was confirmed at resection of the left lower lobe.
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Figure 4b. Patient 10. Rhizopus species infection in a 53-year-old woman with cough, fever, and chest pain at presentation 2 months after right single-lung transplantation for emphysema. (a) Posteroanterior chest radiograph shows cavitary mass in the native left lower lobe (arrows). Opacities in the right lung (allograft) were unchanged from those seen on multiple prior radiographs. (b) Transverse chest CT scan (10-mm collimation, lung window) confirms a cavitary mass and an intracavitary mass (M) in the left lower lobe and shows the air crescent sign (arrow). CT-guided aspiration biopsy demonstrated Rhizopus species infection that was confirmed at resection of the left lower lobe.
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Figure 5a. Patient 13. Stage I non-small cell lung cancer in an asymptomatic 56-year-old woman with new radiographic abnormalities 34 months after left single-lung transplantation for emphysema. (a) Posteroanterior chest radiograph shows a well-defined 1.5-cm nodule (arrow) in the native right upper lobe, which was confirmed at CT (not shown). This lesion was not present on surveillance radiographs that had been obtained 6 months earlier (not shown). (b) Coronal FDG-PET scan shows hypermetabolism within the right upper lobe nodule (arrow). No hypermetabolism is seen within hilar or mediastinal lymph nodes. The patient underwent mediastinoscopy and thoracoscopic wedge resection of a right upper lobe nodule. All mediastinal nodes were negative for malignancy. Histopathologic examination of the resected nodule confirmed adenocarcinoma. V = normal left ventricular activity.
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Figure 5b. Patient 13. Stage I non-small cell lung cancer in an asymptomatic 56-year-old woman with new radiographic abnormalities 34 months after left single-lung transplantation for emphysema. (a) Posteroanterior chest radiograph shows a well-defined 1.5-cm nodule (arrow) in the native right upper lobe, which was confirmed at CT (not shown). This lesion was not present on surveillance radiographs that had been obtained 6 months earlier (not shown). (b) Coronal FDG-PET scan shows hypermetabolism within the right upper lobe nodule (arrow). No hypermetabolism is seen within hilar or mediastinal lymph nodes. The patient underwent mediastinoscopy and thoracoscopic wedge resection of a right upper lobe nodule. All mediastinal nodes were negative for malignancy. Histopathologic examination of the resected nodule confirmed adenocarcinoma. V = normal left ventricular activity.
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Figure 6a. Patient 12. Stage IV non-small cell lung cancer in a 57-year-old man with severe right shoulder pain at presentation 9 months after left single-lung transplantation for pulmonary fibrosis. Posteroanterior chest radiograph (not shown) showed only end-stage fibrosis in the native right lung and no pulmonary nodules. (a) Posterior technetium 99m methylene diphosphonate bone scan shows a focal area of increased radiotracer uptake in the scapula (straight arrow). There is a second focus in the left posterior sixth rib (curved arrow). (b) Transverse chest CT (10-mm collimation, bone window) scan obtained with the patient in a prone position for biopsy shows fibrosis and multiple nodules (arrows) in the native right lung. Transthoracic needle aspiration of the scapula confirmed metastatic non-small cell cancer.
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Figure 6b. Patient 12. Stage IV non-small cell lung cancer in a 57-year-old man with severe right shoulder pain at presentation 9 months after left single-lung transplantation for pulmonary fibrosis. Posteroanterior chest radiograph (not shown) showed only end-stage fibrosis in the native right lung and no pulmonary nodules. (a) Posterior technetium 99m methylene diphosphonate bone scan shows a focal area of increased radiotracer uptake in the scapula (straight arrow). There is a second focus in the left posterior sixth rib (curved arrow). (b) Transverse chest CT (10-mm collimation, bone window) scan obtained with the patient in a prone position for biopsy shows fibrosis and multiple nodules (arrows) in the native right lung. Transthoracic needle aspiration of the scapula confirmed metastatic non-small cell cancer.
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Copyright © 2001 by the Radiological Society of North America.
