Thoracic complications following lung transplantation: 64‐MDCT findings

Abstract

The aim of this review is to present the wide spectrum of common and uncommon thoracic complications that can affect the lung after transplantation. These complications were analyzed using 64 multi-detector row helical CT (MDCT). Sixty-four MDCT techniques and parameters are illustrated. Correlations of imaging findings and pathologic and histologic specimens obtained by transbronchial biopsy and broncoalveolar lavage are illustrated in representative cases.

Diaphragmatic palsy following lung transplantation

“…It is also worth highlighting that some causes of diaphragmatic palsy were found to be avoidable, notably pull on the phrenic nerve, manipulation of the mediastinum, use of metallic retractors for the pericardium and injury to the pericardio-phrenic vasculature [ 9 , 35 – 38 , 42 , 45 , 46 ], with two studies observing a decrease in the occurrence of diaphragmatic palsy following the transition from retractor utilisation to suspension sutures or hand-retraction [ 36 , 37 ].…”

“…Hypothermic nerve injury secondary to the application of ice has been identified in various reports. Additionally, pull on the phrenic nerve, manipulation of the mediastinum, use of metallic retractors for the pericardium and injury to the pericardio-phrenic vasculature has been implicated to various extents [ 9 , 19 , 35 – 38 , 42 – 46 ]. Only one study found no impact for using retraction instruments, or even traction of the diaphragm, on the incidence of diaphragmatic palsy [ 12 ].…”

“…Intercostal nerve cryo-analgesia and the risk of diaphragmatic palsy has also been linked and a study suggests refraining from the intervention may lead to a reduction in the risk [ 47 ]. Use of cautery was also found to add to the risk, probably due to the thermal injury [ 36 , 42 , 43 ]. Contrarily, it was determined that electrocautery did not exert an influence on the incidence of diaphragmatic palsy in at least one study [ 12 ].…”