Abstract
Hematopoietic stem cell transplantation (HSCT) has become a standard method for treating patients with hematological malignancies. Preconditioning chemotherapeutic drugs, total body irradiation (TBI), or chronic graft-versus-host disease (GVHD) can cause several chest complications after HSCT. Because immunosuppression is marked after HSCT, it takes at least 1 year for the immune system to recover completely. Therefore, several infectious and noninfectious complications may occur within the year after HSCT. HSCT-specific complications occur in a characteristic temporal sequence associated with the period following HSCT. During the neutropenic phase, bacterial pneumonia, fungal infection, pulmonary edema, and diffuse alveolar hemorrhage may occur. During the early phase, pneumocystis pneumonia, cytomegalovirus pneumonia, engraftment syndrome, and idiopathic pneumonia syndrome are the common complications. During the late phase, constrictive bronchiolitis and organizing pneumonia may occur probably associated with chronic GVHD. Although high-resolution CT findings lack specificity, the frequency and likelihood of occurrence of certain complications in certain phases and sometimes characteristic features (such as a CT halo sign for fungal infection) facilitate early detection of a life-threatening complication.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Khurshid I, Anderson LC. Non-infectious pulmonary complications after bone marrow transplantation. Postgrad Med J 2002;78:257–262.
Wah TM, Moss HA, Robertson RJH, Barnard DL. Pulmonary complications following bone marrow transplantation. Br J Radiol 2003;76:373–379.
Worthy SA, Flint JD, Müller N. Pulmonary complications after bone marrow transplantation: high-resolution CT and pathologic findings. Radiographics 1997;17:1359–1371.
Lim do H, Lee J, Lee HG, Park BB, Peck KR, Oh WS, et al. Pulmonary complications after hematopoietic stem cell transplantation. J Korean Med Sci 2006;21:406–411.
Winn WC, LaSala PR, Leslie KO. Bacterial infections. In: Tomashefski JF, editor. Dail and Hammar’s pulmonary pathology. Vol 1. Nonneoplastic lung disease. 3rd edn. New York: Springer; 2008. p. 228–315.
Primack SL, Hartman TE, Lee KS, Müller NL. Pulmonary nodules and the CT halo sign. Radiology 1994;190:513–515.
Gefter WB, Albelda SM, Talbot GH, Gerson SL, Cassileth PA, Miller WT. Invasive pulmonary aspergillosis and acute leukemia: limitations in the diagnostic utility of the air crescent sign. Radiology 1985;157:605–610.
Franquet T, Müller NL, Lee KS, Giménez A, Flint JD. Highresolution CT and pathologic findings of noninfectious pulmonary complications after hematopoietic stem cell transplantation. AJR Am J Roentgenol 2005;184:629–637.
Afessa B, Tefferi A, Litzow MR, Krowka MJ, Wylam ME, Peters SG. Diffuse alveolar hemorrhage in hematopoietic stem cell transplant recipients. Am J Respir Crit Care Med 2002;166:641–645.
Bergin CJ, Wirth RL, Berry GJ, Castellino RA. Pneumocystis carinii pneumonia: CT and HRCT observations. J Comput Assist Tomogr 1990;14:756–759.
Moon JH, Kim EA, Lee KS, Kim TS, Jung KJ, Song JH. Cytomegalovirus pneumonia: high-resolution CT findings in ten non-AIDS immunocompromised patients. Korean J Radiol 2000;1:73–78.
Franquet T, Lee KS, Müller NL. Thin-section CT findings in 32 immunocompromised patients with cytomegalovirus pneumonia who do not have AIDS. AJR Am J Roentgenol 2003;181:1059–1063.
Clark JG, Hansen JA, Hertz MI, Parkman R, Jensen L, Peavy HH. NHLBI workshop summary: idiopathic pneumonia syndrome after bone marrow transplantation. Am Rev Respir Dis 1993;147:1601–1606.
Cooke KR, Yanik G. Acute lung injury after allogeneic stem cell transplantation: is the lung a target of acute graft-versushost disease? Bone Marrow Transplant 2004;34:753–765.
Yousem SA. The histological spectrum of pulmonary graft-versus-host disease in bone marrow transplant recipients. Hum Pathol 1995;26:668–675.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Tanaka, N., Kunihiro, Y., Yujiri, T. et al. High-resolution computed tomography of chest complications in patients treated with hematopoietic stem cell transplantation. Jpn J Radiol 29, 229–235 (2011). https://doi.org/10.1007/s11604-010-0544-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11604-010-0544-8