Chest Imaging

Noninfectious Pulmonary Complications after Hematopoietic Stem Cell Transplantation: Practical Approach to Imaging Diagnosis

Published Online:May 1 2014https://doi.org/10.1148/rg.343135080

Abstract

A timeline for the clinical, radiologic, and pathologic manifestations of posttransplant noninfectious pulmonary complications is presented, with emphasis on high-resolution CT findings and a practical approach to imaging interpretation.

Hematopoietic stem cell transplantation (HSCT) is a widely available treatment for a variety of malignant and nonmalignant disorders. The treatment outcome is affected by the type of transplant and is limited by complications secondary to immunosuppression and treatment-related toxicity. Pulmonary complications are very common and follow a predictable timeline that reflects the immunologic status of the patient in the peritransplant period. Until recently, pulmonary complications were largely attributed to infectious causes. However, advances in diagnosis and treatment have led to a shift, and noninfectious complications have emerged as a major cause of morbidity and mortality in this population. With the increasing number of centers that perform HSCT, knowledge of posttransplant noninfectious pulmonary complications has become increasingly relevant. The basic principles of and indications for HSCT are described, and a timeline for the clinical, radiologic, and pathologic manifestations of noninfectious pulmonary complications is presented. Emphasis is given to high-resolution computed tomographic findings and the role of imaging in management of complications. A practical approach is provided to guide imaging interpretation and diagnosis of noninfectious pulmonary complications after HSCT.

©RSNA, 2014

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Article History

Received: May 6 2013
Revision requested: June 28 2013
Revision received: Aug 22 2013
Accepted: Aug 29 2013
Published online: May 2014
Published in print: May 2014

Vol. 34, No. 3

Abbreviations

Abbreviations:
ALS	air-leak syndrome
BAL	bronchoalveolar lavage
DAH	diffuse alveolar hemorrhage
GVHD	graft versus host disease
H-E	hematoxylin-eosin
HRCT	high-resolution CT
HSCT	hematopoietic stem cell transplantation
IPS	idiopathic pneumonia syndrome
PAP	pulmonary alveolar proteinosis
PERDS	periengraftment respiratory distress syndrome
PTLD	posttransplant lymphoproliferative disorder
PVOD	pulmonary venoocclusive disease

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