Presentation
Admitted with sepsis and shortness of breath. Infection?
Patient Data
There is marked volume loss of the right hemithorax with elevation of the right hemidiaphragm and ipsilateral 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 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 (proven pathologically). Transplanted left lung has a normal appearance with no evidence of fibrosis, focal lung nodules or air trapping on the expiratory scans.
Incidental note is made of diffuse calcification of the right coronary artery (RCA) and focal dense calcification in the left anterior descending artery (LAD) .
This is the pretransplant chest xray.
The heart is not enlarged.
The lung volumes are markedly 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.