Radiological spectrum of pulmonary infections in patients post solid organ transplantation.

Abstract

SummaryPneumonia remains an important source of morbidity and mortality in transplant recipients. Since clinical findings are nonspecific and cultures may be time-consuming, imaging plays an important role in establishing the probable etiology of pneumonia. Plain films are used as an initial study. However, they have a limited capacity in differentiating the causative factors. HRCT is used as a problem-solving tool in patients with unclear plain film findings and/or no response to treatment. The main advantage of HRCT is a very detailed depiction of the lung parenchyma. Even though HRCT findings are not always specific, there are several sings that are more common in certain types of pneumonia. The aim of the article is to present radiological findings suggestive of a particular causative microorganism and show how they can narrow the differential diagnosis when coupled with clinical data.

ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompromised Patients

“…Chest radiographs also demonstrate the presence of complicating features of pneumonia, such as empyema or abscess. 5 CT is more sensitive and specific than chest radiography for detecting subtle pulmonary findings. Although not recommended for the initial imaging evaluation of patients with ARI, the use of CT has been described in several scenarios with respect to the immunocompromised host: to evaluate patients who are clinically symptomatic for ARI but who have equivocal or normal chest radiographic findings, to better characterize abnormal but nonspecific chest radiograph findings, and to provide essential information for determining the appropriate method and site of lung biopsy.…”

“…The appearance and distribution of lung abnormalities on CT, coupled with information of the patient's clinical presentation, are often quite helpful in formulating a differential diagnosis. 2,5,12,13,[15][16][17][18][19][20][21][22][23] In patients whose primary immune defect is human immunodeficiency virus infection, a normal or near-normal chest radiograph can occasionally occur when they are infected with TB, 24 nontuberculous mycobacteria, or PJP. 2,25 In the setting of a human immunodeficiency virus infection, if there is a high clinical suspicion of a pulmonary infection along with a normal or near-normal chest radiograph, a CT may be warranted to assess for subtle pulmonary parenchymal disease.…”

Posttransplant Lymphoproliferative Disorder in Children: A 360-degree Perspective

“…Imaging may suggest the responsible microorganism, and hence can help to guide therapy. For example, in patients with a posttransplant chest infection, CT findings may suggest the causative organism when they are interpreted in the appropriate clinical context (93).…”