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Bronchogenic Carcinoma after Lung Transplantation: Frequency, Clinical Characteristics, and Imaging Findings¹

¹ From the Depts of Radiology (J.C.) and Cardiothoracic Surgery (R.B.L.), Univ of Wisconsin Hospital and Clinics, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; Dept of Radiology, Univ of Michigan Medical School, Ann Arbor (E.A.K.); Dept of Radiology, Univ of Pittsburgh Medical School, Pa (J.L.); Dept of Radiology, Duke Univ Medical School, Durham, NC (H.P.M.); Dept of Radiology, Stanford Univ Medical School, Stanford, Calif (A.N.L.); Dept of Radiology, College of Physicians and Surgeons of Columbia Univ, New York, NY (M.S.); and Mallinckrodt Inst of Radiology, Washington Univ School of Medicine, St Louis, Mo (J.S.). Received July 13, 2001; revision requested August 13; revision received October 11; accepted October 25. Address correspondence to J.C. (e-mail: jcollin4@facstaff.wisc.edu).

View larger version (146K): [in a new window]   Figure 1a. Stage IA squamous cell carcinoma detected at surveillance chest radiography in a 70-year-old asymptomatic woman who underwent left lung transplantation for emphysema and had a 45-pack-year history of cigarette smoking. (a) Collimated view of the right middle lung on posteroanterior chest radiograph shows an irregular nodule (arrow) superimposed on a posterior rib. (b) Transverse CT scan (5-mm collimation) obtained 7 days after a shows the irregular right lower lobe nodule (arrow) and emphysema of the native lung. The patient underwent right lower lobectomy and was disease free at the time this article was written.

View larger version (156K): [in a new window]   Figure 1b. Stage IA squamous cell carcinoma detected at surveillance chest radiography in a 70-year-old asymptomatic woman who underwent left lung transplantation for emphysema and had a 45-pack-year history of cigarette smoking. (a) Collimated view of the right middle lung on posteroanterior chest radiograph shows an irregular nodule (arrow) superimposed on a posterior rib. (b) Transverse CT scan (5-mm collimation) obtained 7 days after a shows the irregular right lower lobe nodule (arrow) and emphysema of the native lung. The patient underwent right lower lobectomy and was disease free at the time this article was written.

View larger version (147K): [in a new window]   Figure 2a. Poorly differentiated non-small cell carcinoma adjacent to surgical staples in a 58-year-old woman who underwent left lung transplantation for emphysema and had a 30-pack-year history of cigarette smoking. (a) Collimated view of right upper lobe on posteroanterior chest radiograph shows an irregular opacity (arrow) adjacent to the staple line in the right upper lobe. (b) Posteroanterior detection chest radiograph obtained 5 months after a shows a peripheral well-circumscribed mass in the right upper lobe. At the time this radiograph was obtained, the patient had increasing dyspnea. Surgical staging had not yet been performed at the time this article was written.

View larger version (156K): [in a new window]   Figure 2b. Poorly differentiated non-small cell carcinoma adjacent to surgical staples in a 58-year-old woman who underwent left lung transplantation for emphysema and had a 30-pack-year history of cigarette smoking. (a) Collimated view of right upper lobe on posteroanterior chest radiograph shows an irregular opacity (arrow) adjacent to the staple line in the right upper lobe. (b) Posteroanterior detection chest radiograph obtained 5 months after a shows a peripheral well-circumscribed mass in the right upper lobe. At the time this radiograph was obtained, the patient had increasing dyspnea. Surgical staging had not yet been performed at the time this article was written.

View larger version (127K): [in a new window]   Figure 3a. Adenocarcinoma misinterpreted as progression of pulmonary fibrosis in a 54-year-old woman who had undergone left lung transplantation and had a 45-pack-year history of cigarette smoking. (a) Posteroanterior baseline chest radiograph shows pulmonary fibrosis in the native lung (right lower lobe). (b) Posteroanterior chest radiograph obtained 7 months after a shows increased opacity and volume loss of the right lower lobe, interpreted as progression of pulmonary fibrosis. (c) Posteroanterior detection chest radiograph obtained 8 months after b shows further increase in right lower lobe opacity. (d) Transverse CT scan (7-mm collimation) obtained 1 month after c shows a mass (M) in the right upper lobe and bilateral pulmonary nodules (arrows). Right hydropneumothorax (P) resulted from biopsy. (e) Same CT scan as in d, with soft-tissue windowing, shows tumor (arrows) invading the mediastinal fat. At the time of the CT examination, the patient had fever, night sweats, chest pain, anorexia, and weight loss. She died 3 days after diagnosis. Autopsy showed lymphangitic tumor spread to the left lung, myocardial metastases, malignant pleural effusions, and left adrenal metastases.

View larger version (107K): [in a new window]   Figure 3b. Adenocarcinoma misinterpreted as progression of pulmonary fibrosis in a 54-year-old woman who had undergone left lung transplantation and had a 45-pack-year history of cigarette smoking. (a) Posteroanterior baseline chest radiograph shows pulmonary fibrosis in the native lung (right lower lobe). (b) Posteroanterior chest radiograph obtained 7 months after a shows increased opacity and volume loss of the right lower lobe, interpreted as progression of pulmonary fibrosis. (c) Posteroanterior detection chest radiograph obtained 8 months after b shows further increase in right lower lobe opacity. (d) Transverse CT scan (7-mm collimation) obtained 1 month after c shows a mass (M) in the right upper lobe and bilateral pulmonary nodules (arrows). Right hydropneumothorax (P) resulted from biopsy. (e) Same CT scan as in d, with soft-tissue windowing, shows tumor (arrows) invading the mediastinal fat. At the time of the CT examination, the patient had fever, night sweats, chest pain, anorexia, and weight loss. She died 3 days after diagnosis. Autopsy showed lymphangitic tumor spread to the left lung, myocardial metastases, malignant pleural effusions, and left adrenal metastases.

View larger version (112K): [in a new window]   Figure 3c. Adenocarcinoma misinterpreted as progression of pulmonary fibrosis in a 54-year-old woman who had undergone left lung transplantation and had a 45-pack-year history of cigarette smoking. (a) Posteroanterior baseline chest radiograph shows pulmonary fibrosis in the native lung (right lower lobe). (b) Posteroanterior chest radiograph obtained 7 months after a shows increased opacity and volume loss of the right lower lobe, interpreted as progression of pulmonary fibrosis. (c) Posteroanterior detection chest radiograph obtained 8 months after b shows further increase in right lower lobe opacity. (d) Transverse CT scan (7-mm collimation) obtained 1 month after c shows a mass (M) in the right upper lobe and bilateral pulmonary nodules (arrows). Right hydropneumothorax (P) resulted from biopsy. (e) Same CT scan as in d, with soft-tissue windowing, shows tumor (arrows) invading the mediastinal fat. At the time of the CT examination, the patient had fever, night sweats, chest pain, anorexia, and weight loss. She died 3 days after diagnosis. Autopsy showed lymphangitic tumor spread to the left lung, myocardial metastases, malignant pleural effusions, and left adrenal metastases.

View larger version (124K): [in a new window]   Figure 3d. Adenocarcinoma misinterpreted as progression of pulmonary fibrosis in a 54-year-old woman who had undergone left lung transplantation and had a 45-pack-year history of cigarette smoking. (a) Posteroanterior baseline chest radiograph shows pulmonary fibrosis in the native lung (right lower lobe). (b) Posteroanterior chest radiograph obtained 7 months after a shows increased opacity and volume loss of the right lower lobe, interpreted as progression of pulmonary fibrosis. (c) Posteroanterior detection chest radiograph obtained 8 months after b shows further increase in right lower lobe opacity. (d) Transverse CT scan (7-mm collimation) obtained 1 month after c shows a mass (M) in the right upper lobe and bilateral pulmonary nodules (arrows). Right hydropneumothorax (P) resulted from biopsy. (e) Same CT scan as in d, with soft-tissue windowing, shows tumor (arrows) invading the mediastinal fat. At the time of the CT examination, the patient had fever, night sweats, chest pain, anorexia, and weight loss. She died 3 days after diagnosis. Autopsy showed lymphangitic tumor spread to the left lung, myocardial metastases, malignant pleural effusions, and left adrenal metastases.

View larger version (119K): [in a new window]   Figure 3e. Adenocarcinoma misinterpreted as progression of pulmonary fibrosis in a 54-year-old woman who had undergone left lung transplantation and had a 45-pack-year history of cigarette smoking. (a) Posteroanterior baseline chest radiograph shows pulmonary fibrosis in the native lung (right lower lobe). (b) Posteroanterior chest radiograph obtained 7 months after a shows increased opacity and volume loss of the right lower lobe, interpreted as progression of pulmonary fibrosis. (c) Posteroanterior detection chest radiograph obtained 8 months after b shows further increase in right lower lobe opacity. (d) Transverse CT scan (7-mm collimation) obtained 1 month after c shows a mass (M) in the right upper lobe and bilateral pulmonary nodules (arrows). Right hydropneumothorax (P) resulted from biopsy. (e) Same CT scan as in d, with soft-tissue windowing, shows tumor (arrows) invading the mediastinal fat. At the time of the CT examination, the patient had fever, night sweats, chest pain, anorexia, and weight loss. She died 3 days after diagnosis. Autopsy showed lymphangitic tumor spread to the left lung, myocardial metastases, malignant pleural effusions, and left adrenal metastases.

View larger version (135K): [in a new window]   Figure 4a. Invasive squamous cell carcinoma visible only at lateral chest radiography in a 62-year-old woman who had sternal pain and had undergone right lung transplantation for emphysema. (a) Collimated view of retrosternal area on lateral chest radiograph shows a mass (arrows) posterior to the sternum and anterior to the aortic arch. (b) Transverse CT scan (5-mm collimation) obtained 10 days after a shows a mass (M) invading the sternum and anterior chest wall.

View larger version (117K): [in a new window]   Figure 4b. Invasive squamous cell carcinoma visible only at lateral chest radiography in a 62-year-old woman who had sternal pain and had undergone right lung transplantation for emphysema. (a) Collimated view of retrosternal area on lateral chest radiograph shows a mass (arrows) posterior to the sternum and anterior to the aortic arch. (b) Transverse CT scan (5-mm collimation) obtained 10 days after a shows a mass (M) invading the sternum and anterior chest wall.

View larger version (133K): [in a new window]   Figure 5a. Subtle squamous cell carcinoma visible at chest CT in an asymptomatic 60-year-old man who had undergone left lung transplantation for emphysema and had a history of cigarette smoking. (a) Transverse surveillance CT scan (7-mm collimation) shows a small irregular nodule (arrow) in the right middle lobe. (b) Transverse surveillance CT scan (7-mm collimation) obtained 6 months after a shows enlargement of the nodule (arrow). (c) Same CT scan as in b, with soft-tissue windowing, shows extensive right hilar (H) and subcarinal (S) necrotic lymph node enlargement and a pericardial effusion (E), new as compared with the prior CT scan. Further work-up showed brain metastases. The patient was treated at an outside institution and was lost to follow-up.

View larger version (137K): [in a new window]   Figure 5b. Subtle squamous cell carcinoma visible at chest CT in an asymptomatic 60-year-old man who had undergone left lung transplantation for emphysema and had a history of cigarette smoking. (a) Transverse surveillance CT scan (7-mm collimation) shows a small irregular nodule (arrow) in the right middle lobe. (b) Transverse surveillance CT scan (7-mm collimation) obtained 6 months after a shows enlargement of the nodule (arrow). (c) Same CT scan as in b, with soft-tissue windowing, shows extensive right hilar (H) and subcarinal (S) necrotic lymph node enlargement and a pericardial effusion (E), new as compared with the prior CT scan. Further work-up showed brain metastases. The patient was treated at an outside institution and was lost to follow-up.

View larger version (104K): [in a new window]   Figure 5c. Subtle squamous cell carcinoma visible at chest CT in an asymptomatic 60-year-old man who had undergone left lung transplantation for emphysema and had a history of cigarette smoking. (a) Transverse surveillance CT scan (7-mm collimation) shows a small irregular nodule (arrow) in the right middle lobe. (b) Transverse surveillance CT scan (7-mm collimation) obtained 6 months after a shows enlargement of the nodule (arrow). (c) Same CT scan as in b, with soft-tissue windowing, shows extensive right hilar (H) and subcarinal (S) necrotic lymph node enlargement and a pericardial effusion (E), new as compared with the prior CT scan. Further work-up showed brain metastases. The patient was treated at an outside institution and was lost to follow-up.

View larger version (180K): [in a new window]   Figure 6a. Squamous cell carcinoma visible at CT in an asymptomatic 63-year-old man who had undergone left lung transplantation for emphysema and had a 200-pack-year history of cigarette smoking. (a) Transverse CT scan (5-mm collimation) shows an irregular opacity (arrows) in the right lower lobe. (b) Transverse CT scan (5-mm collimation) obtained 4 months after a shows a nodule with central lucency (arrow) in the right lower lobe. (c) Transverse high-resolution CT scan (1-mm collimation) obtained 9 months after b shows a mass (M) and irregular interlobular and intralobular septal thickening, representing lymphangitic tumor spread, in the right lower lobe. The patient died 2 months after diagnosis.

View larger version (169K): [in a new window]   Figure 6b. Squamous cell carcinoma visible at CT in an asymptomatic 63-year-old man who had undergone left lung transplantation for emphysema and had a 200-pack-year history of cigarette smoking. (a) Transverse CT scan (5-mm collimation) shows an irregular opacity (arrows) in the right lower lobe. (b) Transverse CT scan (5-mm collimation) obtained 4 months after a shows a nodule with central lucency (arrow) in the right lower lobe. (c) Transverse high-resolution CT scan (1-mm collimation) obtained 9 months after b shows a mass (M) and irregular interlobular and intralobular septal thickening, representing lymphangitic tumor spread, in the right lower lobe. The patient died 2 months after diagnosis.

View larger version (178K): [in a new window]   Figure 6c. Squamous cell carcinoma visible at CT in an asymptomatic 63-year-old man who had undergone left lung transplantation for emphysema and had a 200-pack-year history of cigarette smoking. (a) Transverse CT scan (5-mm collimation) shows an irregular opacity (arrows) in the right lower lobe. (b) Transverse CT scan (5-mm collimation) obtained 4 months after a shows a nodule with central lucency (arrow) in the right lower lobe. (c) Transverse high-resolution CT scan (1-mm collimation) obtained 9 months after b shows a mass (M) and irregular interlobular and intralobular septal thickening, representing lymphangitic tumor spread, in the right lower lobe. The patient died 2 months after diagnosis.