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Figure 3b. Acute rejection in a patient with bilateral lung transplants for end-stage pulmonary fibrosis secondary to sarcoidosis. (a) Radiograph, obtained over 3 weeks after transplantation, shows pleural effusions, airspace opacities (arrow), and interlobular septal thickening. (b) Axial CT image shows patchy and multifocal bilateral ground-glass opacities, peribronchial and septal thickening (arrow), and pleural effusion due to acute cellular rejection. (c) High-power photomicrograph (original magnification, x200; hematoxylin-eosin [H–E] stain) of a transbronchial biopsy specimen shows moderate (A3) acute rejection, with a marked perivascular inflammatory infiltrate of mononuclear cells (arrow) that extends into alveolar septa and without evident pneumocyte damage.
