CT of Heart Transplant Recipients: Spectrum of Disease1
Friedrich D. Knollmann, MD ,
Manfred Hummel, MD ,
Roland Hetzer, MD, PhD and
Roland Felix, MD, PhD
1 From the Strahlenklinik, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany (F.D.K., R.F.); and the Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Germany (M.H., R.H.). Presented as a scientific exhibit at the 1999 RSNA scientific assembly. Received March 27, 2000; revision requested May 5 and received June 2; accepted June 26. Address correspondence to F.D.K. (e-mail: friedrich.knollmann@charite.de).
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Figure 1. Graph illustrates the distribution of causes of death in heart transplant recipients within 1 year after surgery at the German Heart Institute Berlin between 1986 and 1999.
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Figure 2. Graph illustrates the distribution of causes of death in heart transplant recipients more than 1 year after surgery at the German Heart Institute Berlin between 1986 and 1999.
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Figure 3. Graph illustrates the anatomic distribution of CT studies performed in heart transplant recipients at the German Heart Institute Berlin between 1986 and 1999.
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Figure 4a. Lung abscess with cavitation. CT scans obtained with mediastinal windowing (a) and lung windowing (b) demonstrate a lung abscess with cavitation caused by both Klebsiella pneumoniae and Legionella species.
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Figure 4b. Lung abscess with cavitation. CT scans obtained with mediastinal windowing (a) and lung windowing (b) demonstrate a lung abscess with cavitation caused by both Klebsiella pneumoniae and Legionella species.
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Figure 5a. Pulmonary aspergillosis. CT scans obtained with mediastinal windowing (a) and lung windowing (b) demonstrate isolated pulmonary aspergillosis with an upper lobe predilection and cavitation.
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Figure 5b. Pulmonary aspergillosis. CT scans obtained with mediastinal windowing (a) and lung windowing (b) demonstrate isolated pulmonary aspergillosis with an upper lobe predilection and cavitation.
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Figure 6. Extensive soft-tissue inflammation and abscess formation. CT scan demonstrates extensive soft-tissue inflammation and an abscess with a contrast-enhancing rim in the right thigh caused by Nocardia species.
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Figure 7. Mediastinitis. CT scan displays drainage tubes (arrow) and mediastinal air inclusions as well as retrosternal fluid accumulation. The patient was treated surgically.
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Figure 8a. Intracranial abscess formation. Unenhanced (a) and contrast-enhanced (b) CT scans demonstrate the delayed appearance of ringlike contrast enhancement, which suggested bacterial brain abscesses. This finding was confirmed at surgery.
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Figure 8b. Intracranial abscess formation. Unenhanced (a) and contrast-enhanced (b) CT scans demonstrate the delayed appearance of ringlike contrast enhancement, which suggested bacterial brain abscesses. This finding was confirmed at surgery.
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Figure 9. Cerebral infarction. CT scan shows a hypoattenuating lesion with rim enhancement (arrow) caused by cerebral infarction.
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Figure 10. Necrotizing pancreatitis in a 54-year-old man. CT scan of the upper abdomen demonstrates signs of necrotizing pancreatitis including peripancreatic fluid accumulation and pancreatic edema.
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Figure 11. Invasive aspergillosis. CT scan shows nodular infiltration caused by invasive aspergillosis. The lesion demonstrates a ground-glass-attenuation rim but no cavitation.
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Figure 12a. Cerebral aspergillosis with intralesional hemorrhage in a 55-year-old woman who presented with severe neurologic deficit. (a, b) Unenhanced (a) and contrast-enhanced (b) CT scans demonstrate the delayed appearance of bifrontal hypoattenuating cerebral defects with rim enhancement due to cerebral aspergillosis. (c) CT scan obtained 9 days later while the patient was undergoing fungistatic therapy reveals intralesional hemorrhage with intense contrast enhancement. Intracranial aspergillosis was confirmed at autopsy.
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Figure 12b. Cerebral aspergillosis with intralesional hemorrhage in a 55-year-old woman who presented with severe neurologic deficit. (a, b) Unenhanced (a) and contrast-enhanced (b) CT scans demonstrate the delayed appearance of bifrontal hypoattenuating cerebral defects with rim enhancement due to cerebral aspergillosis. (c) CT scan obtained 9 days later while the patient was undergoing fungistatic therapy reveals intralesional hemorrhage with intense contrast enhancement. Intracranial aspergillosis was confirmed at autopsy.
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Figure 12c. Cerebral aspergillosis with intralesional hemorrhage in a 55-year-old woman who presented with severe neurologic deficit. (a, b) Unenhanced (a) and contrast-enhanced (b) CT scans demonstrate the delayed appearance of bifrontal hypoattenuating cerebral defects with rim enhancement due to cerebral aspergillosis. (c) CT scan obtained 9 days later while the patient was undergoing fungistatic therapy reveals intralesional hemorrhage with intense contrast enhancement. Intracranial aspergillosis was confirmed at autopsy.
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Figure 13. Allograft rejection in a patient who had undergone heart transplantation several years earlier. CT scan shows an aortic pseudoaneurysm (arrow) and aortic dehiscence caused by allograft rejection.
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Figure 14. Coronary allograft vasculopathy in a 54-year-old man with a total calcium score of 73 and 75% stenosis of the first diagonal branch at angiography. Electron beam CT scan demonstrates significant calcification of the proximal left anterior descending artery (arrow).
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Figure 15. Graph illustrates the correlation between coronary artery calcium load and obstructive disease in 50 heart transplant recipients seen at the German Heart Institute Berlin between 1997 and 1999.
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Figure 16. Graph illustrates the distribution of tumors (n = 50) in heart transplant patients seen at the German Heart Institute Berlin between 1986 and 1999.
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Figure 17a. Lymphoma in a 37-year-old man. (a) Upper gastrointestinal radiograph reveals severe jejunal obstruction due to lymphoma (arrow). Note also the presence of a cardiac pacemaker device in the upper abdomen, which also serves to record an intramyocardial electrocardiogram. The electrocardiogram is transmitted to the transplant center via telephone on a daily basis for early detection of rejection. This procedure has made routine myocardial biopsy obsolete at our center but usually obviates the use of magnetic resonance (MR) imaging in heart transplant recipients. (b) CT scan helps confirm severe intestinal obstruction due to wall thickening (arrow). The lesion was surgically confirmed as an intestinal lymphoma. (c) CT scan shows multiple hepatic areas of hypoattenuation (arrow) that also proved to be due to lymphoma.
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Figure 17b. Lymphoma in a 37-year-old man. (a) Upper gastrointestinal radiograph reveals severe jejunal obstruction due to lymphoma (arrow). Note also the presence of a cardiac pacemaker device in the upper abdomen, which also serves to record an intramyocardial electrocardiogram. The electrocardiogram is transmitted to the transplant center via telephone on a daily basis for early detection of rejection. This procedure has made routine myocardial biopsy obsolete at our center but usually obviates the use of magnetic resonance (MR) imaging in heart transplant recipients. (b) CT scan helps confirm severe intestinal obstruction due to wall thickening (arrow). The lesion was surgically confirmed as an intestinal lymphoma. (c) CT scan shows multiple hepatic areas of hypoattenuation (arrow) that also proved to be due to lymphoma.
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Figure 17c. Lymphoma in a 37-year-old man. (a) Upper gastrointestinal radiograph reveals severe jejunal obstruction due to lymphoma (arrow). Note also the presence of a cardiac pacemaker device in the upper abdomen, which also serves to record an intramyocardial electrocardiogram. The electrocardiogram is transmitted to the transplant center via telephone on a daily basis for early detection of rejection. This procedure has made routine myocardial biopsy obsolete at our center but usually obviates the use of magnetic resonance (MR) imaging in heart transplant recipients. (b) CT scan helps confirm severe intestinal obstruction due to wall thickening (arrow). The lesion was surgically confirmed as an intestinal lymphoma. (c) CT scan shows multiple hepatic areas of hypoattenuation (arrow) that also proved to be due to lymphoma.
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Figure 18. Non-Hodgkin lymphoma. CT scan shows nodular pulmonary infiltration caused by non-Hodgkin lymphoma (arrowhead).
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Figure 19. Non-Hodgkin lymphoma. CT scan demonstrates renal obstruction and widespread retroperitoneal infiltration caused by non-Hodgkin lymphoma.
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Figure 20. Pararenal bacterial abscess. CT scan shows a pararenal bacterial abscess, which appears similar to lymphoma and is therefore an important consideration in the differential diagnosis for lymphoma.
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Figure 21. B-cell non-Hodgkin lymphoma. CT scan obtained at the level of the hyoid bone shows a lateral cervical lymphoma with no spinal involvement (arrow). The mass is inferior to the left sternocleidoid muscle and displaces the left jugular vein laterally.
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Figure 22. Skin malignancy. CT scan demonstrates a left retroauricular mass (arrow) with local lymph node involvement. The mass proved to be due to squamous cell carcinoma. Treatment consisted of excision of the entire outer ear and neck dissection.
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Figures 23. FK-506induced leukoencephalopathy in a 66-year-old man. Cranial CT scan shows white matter disease (arrow) caused by FK-506 toxicity with an appearance that is indistinguishable from that of cyclosporine-induced leukoencephalopathy.
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Figure 24. Internal hydrocephalus in a 61-year-old woman. Cranial CT scan reveals bilateral periventricular areas of hypoattenuation caused by internal hydrocephalus (arrow) with an appearance similar to that of cyclosporine-induced toxicity. Differentiation from cyclosporine-induced leukoencephalopathy was made on the basis of earlier CT findings and clinical history.
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Figure 25a. Fractures due to osteoporosis. (a) Axial CT scan demonstrates a vertebral body fracture (arrow). (b) Sagittal two-dimensional reconstructed image demonstrates an anterior vertebral fracture (arrow).
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Figure 25b. Fractures due to osteoporosis. (a) Axial CT scan demonstrates a vertebral body fracture (arrow). (b) Sagittal two-dimensional reconstructed image demonstrates an anterior vertebral fracture (arrow).
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Figure 26. Thoracic lipomatosis. CT scan clearly demonstrates thoracic lipomatosis (arrow) resulting from immunosuppressive therapy.
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Figure 27. Bar graph illustrates thoracic fat distribution in 98 heart transplant recipients without significant coronary stenosis. The graph displays the frequency distribution of the ratio of transsectional fat density area to transsectional total body area at the level of the carina. Bell curve represents normal distribution.
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Figure 28. Bar graph illustrates thoracic fat distribution in 16 heart transplant recipients with more than 50% coronary artery stenosis. The graph displays the frequency distribution of the ratio of transsectional fat density area to transsectional total body area at the level of the carina. Bell curve represents normal distribution.
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Copyright © 2000 by the Radiological Society of North America.
