Bronchiolitis obliterans in heart-lung transplantation patients: radiologic findings in 11 patients

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Abstract
Patients who survive the postoperative period after combined heart-lung transplantation are at risk for developing progressive airway damage consisting of central bronchiectasis and bronchiolitis obliterans. The cause of these abnormalities is uncertain, but they are thought to represent a form of chronic rejection. The chest radiographs and medical records of 11 transplantation patients with proved bronchiolitis obliterans were reviewed retrospectively. A pathologic diagnosis was made by open-lung biopsy (five patients), transbronchial biopsy (three patients), and autopsy (two patients). Clinical criteria alone were used for diagnosis in one patient. In all patients, the chest radiographs showed parenchymal abnormalities consisting of linear-nodular, nodular, confluent nodular, or diffuse alveolar opacities. Radiographic evidence of central bronchiectasis was present in nine of the 11 patients. This feature was not present on chest radiographs of five randomly selected asymptomatic transplant patients. We conclude that the parenchymal lung changes in bronchiolitis obliterans in transplant patients are nonspecific and are radiographically indistinguishable from other infectious and noninfectious complications. The presence of central bronchiectasis (nine of the 11 patients) may be a distinctive radiographic finding in this group of patients.