Presentation
Transplant patient. Shortness of breath.
Patient Data
Median sternotomy.
Subtle peripheral airspace opacification in both mid zones.
3 days later. More unwell. Greater oxygen requirements
Median sternotomy.
Subtle bilateral airspace change in both mid zones, which is a little more pronounced than on the prior radiograph.
3 days later. Fever. Increasing oxygen requirements.
Median sternotomy.
Moderate bilateral peripheral airspace opacification in both lungs with only the apices spared. This has progressed since the prior film.
No pleural effusion.
10 days later. Unable to wean. Low oxygen SpO2.
Extensive bilateral parenchymal changes predominantly in both lower lobes and peripherally with a pattern predominantly of organizing pneumonia (lobular sparing and fuzzy arcades in patches with distortion of the airways). The apical segments of both upper lobes are relatively spared.
No pleural effusions or empyema.
No significant mediastinal lymphadenopathy.
Case Discussion
This case illustrates progressive imaging findings correlating with clinical deterioration in a susceptible patient (age and immunosuppressive medications).