Chronic lung allograft dysfunction - restrictive form

Case contributed by Dr Bruno Di Muzio

Presentation

Bilateral lung transplant with further redo of the right lung.

Patient Data

Age: 50 years
Gender: Male

The right lung and pleural spaces have unremarkable appearances, with no infiltrate, relevant bronchiectasis, or air-trapping. The left lung shows a degree of volume loss associated with irregular subpleural consolidations, band atelectasis, and cylindrical bronchiectasis. On expiratory series, there are the appearances of diffuse left lung air-trapping suggestive of bronchiolitis obilterans syndrome. The mediastinal structures are unremarkable for this protocol. Diffuse hepatic steatosis noted.  

X-ray

Chest radiographs (1 year later)

The left lung shows volume loss with likely pleural thickening and peripheral/subpleural airspace atelectasis/consolidation, but no associated mediastinal shift towards the left. The right lung and pleural spaces are mostly clear, with perhaps some basal band atelectasis. 

CT

CT Chest (1 year later)

Although the right lung demonstrates slightly more prominent bronchi when compared to the last imaging, it has otherwise unremarkable appearances, with no signs of infiltrates or consolidation. The left lung has severely reduced in size and shows diffuse peribronchial infiltrate and also partial atelectasis and consolidative changes in the upper lobe. No pleural effusions. The mediastinal structures are unremarkable, no lymphadenopathy. The imaged superior abdomen shows diffuse hepatic steatosis.

Case Discussion

The left lung opacities seen on the plain films are in keeping with further volume loss and progression of the likely restrictive form of chronic lung allograft dysfunction (CLAD). The right transplanted lung has no imaging features to suggest rejection. 

Interestingly, the appearances of the left lung one year ago showed features supportive of bronchiolitis obliterans syndrome. Either the obstructive and the restrictive forms of CLAD may evolve one to another along the post-transplant period. 

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Case information

rID: 60595
Published: 8th Jun 2018
Last edited: 9th Jun 2018
System: Chest
Inclusion in quiz mode: Included

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