The CT Findings And Clinical Analysis Of Pulmonary Complications In Hematopoietic Stem Cell Transplantation

Objective:To investigate the CT findings and dynamic change of pulmonary complications in hematopoietic stem cell transplantation (HSCT) recipients.Material and Methods:The CT findings of pulmonary complications in 42 HSCT recipients were analyzed. Nodule, mass, cavity, ground-glass opacification, air space consolidation, "crazy-paving" pattern, reticular change, bronchiectasis, pneumothorax, mediastinal and subcutaneous emphysema, and other CT abnormal findings were evaluated comprehensively. The development and change of the diseases were observed.Results:24 episodes of pulmonary complications which were final diagnosed or clinical diagnosed were documented in 23 patients. Pulmonary complications were due to fungal pneumonia (n=14), cytomegalovirus pneumonia (n=4), bacterial pneumonia (n=3), bronchiolitis obliterans (BO, n=1), leukemia pulmonary infiltrates (n=1) and lung acidosis (n=1).Regarding the fungal pneumonia, the most frequent features were nodules, masses, or nodules and masses (n=12), and there were 18 cavitations in course of fungal pneumonia in 10 patients,8 cavitations showed septation pattern and 5 cavitations were surrounded with halo sign among them. Areas of ground-glass opacification were seen in all the patients with cytomegalovirus pneumonia, Air-space consolidation (n=3) and reticular changes (n=3) were also identified. The most common CT findings of bacterial pneumonia were air-space consolidation (n=3) and nodule (n=3). In BO, CT revealed bronchial dilatation and bronchial wall thickening. The CT finding of leukemia pulmonary infiltration was single nodule surrounding with halo sign. Lung sarcoidosis showed mediastinal and hilar adenopathy, patchy of air-space consolidation co-existed with miliary nodules. Among these 42 patients, "crazy-paving" pattern were identified in 3 (7%) cases. The 3 patients died of respiratory failure within 40 days after the CT examination. Symmetry bronchiectasis were observed in 9 (21%) cases. Spontaneous pneumothorax or pneumo mediastinum, subcutaneous emphysema were observed in 8 (19%) cases.Conclusions:The CT findings of pulmonary complications in HSCT recipients are various, the cavitation with septation pattern or halo sign strongly suggests fungal pneumonia. The "crazy-paving" pattern possibly suggests poor prognosis. HSCT recipients occur symmetry bronchiectasis which may be expression of chronic graft-versus-host in the lungs. HSCT recipients are prone to appearing pneumothorax or pneumomediastinum, subcutaneous emphysema.