Pulmonary fibrosis with unilateral lung transplant

Case contributed by Dr Mark Hall

Presentation

Admitted with sepsis and shortness of breath. Infection?

Patient Data

Age: 66
Gender: Male

There is volume loss of the right hemithorax with elevation of the right hemidiaphragm and mediastinal shift.  There are coarse reticular markings of the right lung.  The left lung is clear.  

There is evidence of left single lung transplant with clips see at the left hilum.

There is extensive fibrotic change throughout the right lung with honeycombing.  There is relative sparing of the lung apex and appearances are in keeping with Usual interstitial pneumonia (UIP proven pathologically). Transplanted left lung has a normal appearance with no evidence of a fibrosis, focal lung nodules or of air trapping on the expiratory scans.

Incidental note is made of diffuse calcification of the right coronary artery and focal dense calcification in the LAD.

This is the pretransplant chest xray.  

The heart is not enlarged.

The lung volumes are reduced and there is a coarse reticular pattern.  The appearances are consistent with advanced pulmonary fibrotic disease.  
 

Case Discussion

Unilateral pulmonary fibrosis is vanishingly rare and should lead the reporter to consider a single lung transplant.

The differential is pulmonary vein thrombosis, ipsilateral single-lung ventilation, or radiation pneumonitis.

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Case information

rID: 52114
Case created: 22nd Mar 2017
Last edited: 16th Aug 2017
System: Chest
Inclusion in quiz mode: Included

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