Presentation
Recent post bilateral lung transplant underwent bronchoscopy and transbronchial biopsy.
Patient Data
CT demonstrates a tubular density with focal gas at the anterior segment of right lower lobe allograft resembles a pseudocavity, associated with surrounding ground glass density. Additional findings of small right pleural effusion and trace left pneumothorax with pleural drains in situ.
The findings concur with the interventional pulmonologist reports of transbronchial biopsy site. The perilesional ground glass density represent mild hemorrhage.
Case Discussion
Radiologists should be aware of the expected CT appearance following a transbronchial biopsy. A pseudocavity is formed when a strip of parenchymal tissue is removed via biopsy forceps.
A postbiopsy pseudocavity represents a tubular density with air within and hence mimics an infected cavity, pneumatocele, bronchocele, or suspicious nodule. A direct communication of this pseudocavity to the adjacent airway may be seen.
Awareness of this iatrogenic cause is imperative to avoid further unnecessary radiation and work-up. Communication with treating chest specialist is strongly advisable.
This typical post biopsy change mostly resolves spontaneously and does not require imaging follow up.
This case is submitted with input from Jeffrey P Kanne, MD, FACR, FFCP (Professor (CHS) and Section Chief Thoracic Imaging).
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