RadioGraphics
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

DOI: 10.1148/rg.252045037
This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME Test (opens in a new window)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Coy, D. L.
Right arrow Articles by Lalani, T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Coy, D. L.
Right arrow Articles by Lalani, T.
Related Collections
Right arrow Chest Radiology
Right arrow Gastrointestinal Radiology
Right arrow Genitourinary Radiology
Right arrowRelated Article

Imaging Evaluation of Pulmonary and Abdominal Complications Following Hematopoietic Stem Cell Transplantation1

David L. Coy, MD, PhD, Amaya Ormazabal, MD, J. David Godwin, MD and Tasneem Lalani, MD, MS

1 From the Department of Radiology, University of Washington, RR 215 Health Sciences Building, Box 357115, 1959 NE Pacific, Seattle, WA 98195-7115. Presented as an education exhibit at the 2003 RSNA Scientific Assembly. Received March 15, 2004; revision requested June 16 and received July 20; accepted July 22. All authors have no financial relationships to disclose.


View larger version (104K):

[in a new window]
  		Figure 1a.  Pulmonary aspergillosis following hematopoietic stem cell transplantation. (a, b) CT scans obtained in two different patients show solitary nodules, with the nodule in b demonstrating cavitation. (c) CT scan obtained in a third patient shows multiple nodules surrounded by a halo of ground-glass attenuation, a finding that indicates hemorrhage resulting from pulmonary infarction. (d) CT scan obtained in a fourth patient shows tracheobronchial aspergillosis with debris filling the left lower lobe bronchus (arrowheads) and consolidation in the left lower lobe.

 


View larger version (121K):

[in a new window]
  		Figure 1b.  Pulmonary aspergillosis following hematopoietic stem cell transplantation. (a, b) CT scans obtained in two different patients show solitary nodules, with the nodule in b demonstrating cavitation. (c) CT scan obtained in a third patient shows multiple nodules surrounded by a halo of ground-glass attenuation, a finding that indicates hemorrhage resulting from pulmonary infarction. (d) CT scan obtained in a fourth patient shows tracheobronchial aspergillosis with debris filling the left lower lobe bronchus (arrowheads) and consolidation in the left lower lobe.

 


View larger version (122K):

[in a new window]
  		Figure 1c.  Pulmonary aspergillosis following hematopoietic stem cell transplantation. (a, b) CT scans obtained in two different patients show solitary nodules, with the nodule in b demonstrating cavitation. (c) CT scan obtained in a third patient shows multiple nodules surrounded by a halo of ground-glass attenuation, a finding that indicates hemorrhage resulting from pulmonary infarction. (d) CT scan obtained in a fourth patient shows tracheobronchial aspergillosis with debris filling the left lower lobe bronchus (arrowheads) and consolidation in the left lower lobe.

 


View larger version (91K):

[in a new window]
  		Figure 1d.  Pulmonary aspergillosis following hematopoietic stem cell transplantation. (a, b) CT scans obtained in two different patients show solitary nodules, with the nodule in b demonstrating cavitation. (c) CT scan obtained in a third patient shows multiple nodules surrounded by a halo of ground-glass attenuation, a finding that indicates hemorrhage resulting from pulmonary infarction. (d) CT scan obtained in a fourth patient shows tracheobronchial aspergillosis with debris filling the left lower lobe bronchus (arrowheads) and consolidation in the left lower lobe.

 


View larger version (165K):

[in a new window]
  		Figure 2a.  DAH following hematopoietic stem cell transplantation. (a) Chest radiograph shows diffuse bilateral consolidation. (b) CT scan obtained in a different patient shows diffuse bilateral ground-glass attenuation with a superimposed reticular pattern representing thickened inter- and intralobular septa.

 


View larger version (155K):

[in a new window]
  		Figure 2b.  DAH following hematopoietic stem cell transplantation. (a) Chest radiograph shows diffuse bilateral consolidation. (b) CT scan obtained in a different patient shows diffuse bilateral ground-glass attenuation with a superimposed reticular pattern representing thickened inter- and intralobular septa.

 


View larger version (115K):

[in a new window]
  		Figure 3a.  CMV pneumonia following hematopoietic stem cell transplantation. CT scans obtained in two different patients show small nodules, along with patchy (a) and diffuse (b) ground-glass attenuation.

 


View larger version (130K):

[in a new window]
  		Figure 3b.  CMV pneumonia following hematopoietic stem cell transplantation. CT scans obtained in two different patients show small nodules, along with patchy (a) and diffuse (b) ground-glass attenuation.

 


View larger version (150K):

[in a new window]
  		Figure 4a.  Zygomycetes pneumonia following stem cell transplantation. CT scans obtained in two different patients show patchy consolidation (a) and ground-glass attenuation and nodules (b).

 


View larger version (148K):

[in a new window]
  		Figure 4b.  Zygomycetes pneumonia following stem cell transplantation. CT scans obtained in two different patients show patchy consolidation (a) and ground-glass attenuation and nodules (b).

 


View larger version (135K):

[in a new window]
  		Figure 5.  Varicella zoster pneumonia following stem cell transplantation. CT scan shows scattered small nodules (circles).

 


View larger version (126K):

[in a new window]
  		Figure 6a.  Cryptogenic organizing pneumonia in the late posttransplantation period. CT scans show peripheral consolidation (a) and increased centrilobular attenuation (b).

 


View larger version (126K):

[in a new window]
  		Figure 6b.  Cryptogenic organizing pneumonia in the late posttransplantation period. CT scans show peripheral consolidation (a) and increased centrilobular attenuation (b).

 


View larger version (70K):

[in a new window]
  		Figure 7a.  Constrictive bronchiolitis in the late posttransplantation period. CT scans obtained during inspiration (a) and expiration (b) show hypoattenuating secondary lobules during expiration, which represent airtrapping from obstructed bronchioles.

 


View larger version (71K):

[in a new window]
  		Figure 7b.  Constrictive bronchiolitis in the late posttransplantation period. CT scans obtained during inspiration (a) and expiration (b) show hypoattenuating secondary lobules during expiration, which represent airtrapping from obstructed bronchioles.

 



View larger version (306K):

[in a new window]
  		Figure 8.  Secondary alveolar proteinosis following stem cell transplantation. CT scans obtained at different levels show geographically distributed ground-glass attenuation and interlobular septal thickening.

 


View larger version (118K):

[in a new window]
  		Figure 9a.  Pseudomembranous colitis following stem cell transplantation. CT scans show diffuse wall thickening and edema of adjacent fat in the cecum (a) and sigmoid colon (b).

 


View larger version (101K):

[in a new window]
  		Figure 9b.  Pseudomembranous colitis following stem cell transplantation. CT scans show diffuse wall thickening and edema of adjacent fat in the cecum (a) and sigmoid colon (b).

 


View larger version (105K):

[in a new window]
  		Figure 10.  Candidiasis following stem cell transplantation. CT scan shows small hepatic abscesses (arrowheads) resulting from disseminated candidiasis.

 


View larger version (123K):

[in a new window]
  		Figure 11a.  Hepatic VOD following hematopoietic stem cell transplantation. (a) Right upper quadrant US image demonstrates ascites and marked gallbladder wall thickening (cursors). (b) Doppler US images obtained in a more severely affected transplant recipient show pulsatile hepatofugal portal venous flow (top) and reduced diastolic hepatic arterial flow (bottom) indicated by an elevated resistive index (>0.8).

 


View larger version (89K):

[in a new window]
  		Figure 11b.  Hepatic VOD following hematopoietic stem cell transplantation. (a) Right upper quadrant US image demonstrates ascites and marked gallbladder wall thickening (cursors). (b) Doppler US images obtained in a more severely affected transplant recipient show pulsatile hepatofugal portal venous flow (top) and reduced diastolic hepatic arterial flow (bottom) indicated by an elevated resistive index (>0.8).

 


View larger version (113K):

[in a new window]
  		Figure 12a.  Severe hepatic VOD following stem cell transplantation. Contrast material–enhanced CT scans demonstrate heterogeneous hepatic enhancement (a) and a nonocclusive portal vein thrombus (arrow in b) resulting from slow portal venous flow caused by hepatic sinusoidal obstruction.

 


View larger version (108K):

[in a new window]
  		Figure 12b.  Severe hepatic VOD following stem cell transplantation. Contrast material–enhanced CT scans demonstrate heterogeneous hepatic enhancement (a) and a nonocclusive portal vein thrombus (arrow in b) resulting from slow portal venous flow caused by hepatic sinusoidal obstruction.

 


View larger version (100K):

[in a new window]
  		Figure 13.  Hemorrhagic cystitis following stem cell transplantation. Transverse US image through the bladder shows echogenic intravesicular debris and diffuse bladder wall thickening.

 


View larger version (130K):

[in a new window]
  		Figure 14a.  Acute gastrointestinal GVHD. Contrast-enhanced CT scans through the upper (a), middle (b), and lower (c) abdomen demonstrate fluid-filled bowel loops, ascites, and mucosal enhancement. Severe mucosal damage has resulted in intraluminal hemorrhage (arrowheads in b and c).

 


View larger version (129K):

[in a new window]
  		Figure 14b.  Acute gastrointestinal GVHD. Contrast-enhanced CT scans through the upper (a), middle (b), and lower (c) abdomen demonstrate fluid-filled bowel loops, ascites, and mucosal enhancement. Severe mucosal damage has resulted in intraluminal hemorrhage (arrowheads in b and c).

 


View larger version (128K):

[in a new window]
  		Figure 14c.  Acute gastrointestinal GVHD. Contrast-enhanced CT scans through the upper (a), middle (b), and lower (c) abdomen demonstrate fluid-filled bowel loops, ascites, and mucosal enhancement. Severe mucosal damage has resulted in intraluminal hemorrhage (arrowheads in b and c).

 


View larger version (149K):

[in a new window]
  		Figure 15.  Typhlitis (neutropenic colitis). Contrast-enhanced CT scan demonstrates a shaggy cecum and inflammation of the cecum and terminal ileum.

 


View larger version (82K):

[in a new window]
  		Figure 16.  Benign pneumatosis intestinalis following stem cell transplantation. Contrast-enhanced CT scan (lung window) demonstrates pneumatosis intestinalis.

 


View larger version (134K):

[in a new window]
  		Figure 17.  Chronic gastrointestinal GVHD. CT scan shows concentric bowel wall thickening.

 


View larger version (30K):

[in a new window]
  		Figure 18.  Chart illustrates when specific pulmonary and abdominal complications are most likely to occur following hematopoietic stem cell transplantation.

 




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
RADIOGRAPHICS RADIOLOGY RSNA JOURNALS ONLINE
Copyright © 2005 by the Radiological Society of North America.