Skip to main content

Pulmonary Complications Following Hematopoietic Stem Cell Transplantation: Radiological Considerations

  • Chapter
  • First Online:
Pulmonary and Critical Care Considerations of Hematopoietic Stem Cell Transplantation

Abstract

Imaging study plays an important role in the diagnosis and management of all phases of the HSCT recipients with suspected pulmonary complications. We review the most common infectious and noninfectious posttransplant pulmonary complications emphasizing their imaging manifestations. Although CT is not recommended for the initial evaluation, it is frequently appropriate in those cases with normal, equivocal, or nonspecific radiographic findings. A combination of the clinical information and CT findings, which are sometimes characteristic of several entities, may help the physicians in forming a meaningful differential diagnosis of these disorders and improve the diagnosis and patient care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Yen KT, Lee AS, Krowka MJ, Burger CD. Pulmonary complications in bone marrow transplantation: a practical approach to diagnosis and treatment. Clin Chest Med. 2004;25(1):189–201. https://doi.org/10.1016/S0272-5231(03)00121-7.

    Article  PubMed  Google Scholar 

  2. Shiari A, Nassar M, Soubani AO. Major pulmonary complications following hematopoietic stem cell transplantation: what the pulmonologist needs to know. Respir Med. 2021;185:106493. https://doi.org/10.1016/j.rmed.2021.106493.

    Article  PubMed  Google Scholar 

  3. Soubani AO, Miller KB, Hassoun PM. Pulmonary complications of bone marrow transplantation. Chest. 1996;109(4):1066–77. https://doi.org/10.1378/chest.109.4.1066.

    Article  CAS  PubMed  Google Scholar 

  4. Chi AK, Soubani AO, White AC, Miller KB. An update on pulmonary complications of hematopoietic stem cell transplantation. Chest. 2013;144(6):1913–22. https://doi.org/10.1378/chest.12-1708.

    Article  PubMed  Google Scholar 

  5. Chan CK, Hyland RH, Hutcheon MA. Pulmonary complications following bone marrow transplantation. Clin Chest Med. 1990;11(2):323–32.

    Article  CAS  PubMed  Google Scholar 

  6. Worthy SA, Flint JD, Muller NL. Pulmonary complications after bone marrow transplantation: high-resolution CT and pathologic findings. Radiographics. 1997;17(6):1359–71. https://doi.org/10.1148/radiographics.17.6.9397451.

    Article  CAS  PubMed  Google Scholar 

  7. Ahya VN. Noninfectious acute lung injury syndromes early after hematopoietic stem cell transplantation. Clin Chest Med. 2017;38(4):595–606. https://doi.org/10.1016/j.ccm.2017.07.002.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Alam S, Chan KM. Noninfectious pulmonary complications after organ transplantation. Curr Opin Pulm Med. 1996;2(5):412–8. https://doi.org/10.1097/00063198-199609000-00011.

    Article  CAS  PubMed  Google Scholar 

  9. Evans A, Steward CG, Lyburn ID, Grier DJ. Imaging in haematopoietic stem cell transplantation. Clin Radiol. 2003;58(3):201–14. https://doi.org/10.1016/s0009-9260(02)00475-0.

    Article  CAS  PubMed  Google Scholar 

  10. Wah TM, Moss HA, Robertson RJ, Barnard DL. Pulmonary complications following bone marrow transplantation. Br J Radiol. 2003;76(906):373–9. https://doi.org/10.1259/bjr/66835905.

    Article  CAS  PubMed  Google Scholar 

  11. Janzen DL, Padley SP, Adler BD, Muller NL. Acute pulmonary complications in immunocompromised non-AIDS patients: comparison of diagnostic accuracy of CT and chest radiography. Clin Radiol. 1993;47(3):159–65. https://doi.org/10.1016/s0009-9260(05)81153-5.

    Article  CAS  PubMed  Google Scholar 

  12. Tanaka N, Kunihiro Y, Yujiri T, Ando T, Gondo T, Kido S, et al. High-resolution computed tomography of chest complications in patients treated with hematopoietic stem cell transplantation. Jpn J Radiol. 2011;29(4):229–35. https://doi.org/10.1007/s11604-010-0544-8.

    Article  PubMed  Google Scholar 

  13. Tanaka N, Matsumoto T, Miura G, Emoto T, Matsunaga N. HRCT findings of chest complications in patients with leukemia. Eur Radiol. 2002;12(6):1512–22. https://doi.org/10.1007/s003300101112.

    Article  PubMed  Google Scholar 

  14. Arakawa H, Webb WR. Air trapping on expiratory high-resolution CT scans in the absence of inspiratory scan abnormalities: correlation with pulmonary function tests and differential diagnosis. AJR Am J Roentgenol. 1998;170(5):1349–53. https://doi.org/10.2214/ajr.170.5.9574614.

    Article  CAS  PubMed  Google Scholar 

  15. Franquet T, Gimenez A, Ketai L, Mazzini S, Rial A, Pomar V, et al. Air trapping in COVID-19 patients following hospital discharge: retrospective evaluation with paired inspiratory/expiratory thin-section CT. Eur Radiol. 2022;32:4427. https://doi.org/10.1007/s00330-022-08580-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Tanaka N, Matsumoto T, Miura G, Emoto T, Matsunaga N, Ueda K, et al. Air trapping at CT: high prevalence in asymptomatic subjects with normal pulmonary function. Radiology. 2003;227(3):776–85. https://doi.org/10.1148/radiol.2273020352.

    Article  PubMed  Google Scholar 

  17. Pena E, Souza CA, Escuissato DL, Gomes MM, Allan D, Tay J, et al. Noninfectious pulmonary complications after hematopoietic stem cell transplantation: practical approach to imaging diagnosis. Radiographics. 2014;34(3):663–83. https://doi.org/10.1148/rg.343135080.

    Article  PubMed  Google Scholar 

  18. Kotloff RM, Ahya VN, Crawford SW. Pulmonary complications of solid organ and hematopoietic stem cell transplantation. Am J Respir Crit Care Med. 2004;170(1):22–48. https://doi.org/10.1164/rccm.200309-1322SO.

    Article  PubMed  Google Scholar 

  19. Nusair S, Breuer R, Shapira MY, Berkman N, Or R. Low incidence of pulmonary complications following nonmyeloablative stem cell transplantation. Eur Respir J. 2004;23(3):440–5. https://doi.org/10.1183/09031936.04.00053004.

    Article  CAS  PubMed  Google Scholar 

  20. Coy DL, Ormazabal A, Godwin JD, Lalani T. Imaging evaluation of pulmonary and abdominal complications following hematopoietic stem cell transplantation. Radiographics. 2005;25(2):305–17; discussion 18. https://doi.org/10.1148/rg.252045037.

    Article  PubMed  Google Scholar 

  21. Franquet T, Muller NL, Lee KS, Gimenez A, Flint JD. High-resolution CT and pathologic findings of noninfectious pulmonary complications after hematopoietic stem cell transplantation. AJR Am J Roentgenol. 2005;184(2):629–37. https://doi.org/10.2214/ajr.184.2.01840629.

    Article  PubMed  Google Scholar 

  22. Crawford SW, Hackman RC, Clark JG. Open lung biopsy diagnosis of diffuse pulmonary infiltrates after marrow transplantation. Chest. 1988;94(5):949–53. https://doi.org/10.1378/chest.94.5.949.

    Article  CAS  PubMed  Google Scholar 

  23. Cunningham I. Pulmonary infections after bone marrow transplant. Semin Respir Infect. 1992;7(2):132–8.

    CAS  PubMed  Google Scholar 

  24. Crawford SW. Noninfectious lung disease in the immunocompromised host. Respiration. 1999;66(5):385–95. https://doi.org/10.1159/000029418.

    Article  CAS  PubMed  Google Scholar 

  25. Cardozo BL, Hagenbeek A. Interstitial pneumonitis following bone marrow transplantation: pathogenesis and therapeutic considerations. Eur J Cancer Clin Oncol. 1985;21(1):43–51. https://doi.org/10.1016/0277-5379(85)90199-3.

    Article  CAS  PubMed  Google Scholar 

  26. Cardozo BL, Zoetelief H, van Bekkum DW, Zurcher C, Hagenbeek A. Lung damage following bone marrow transplantation: I. The contribution of irradiation. Int J Radiat Oncol Biol Phys. 1985;11(5):907–14. https://doi.org/10.1016/0360-3016(85)90112-9.

    Article  CAS  PubMed  Google Scholar 

  27. Aronchick JM. Pulmonary infections in cancer and bone marrow transplant patients. Semin Roentgenol. 2000;35(2):140–51. https://doi.org/10.1053/ro.2000.6152.

    Article  CAS  PubMed  Google Scholar 

  28. Choi YH, Leung AN. Radiologic findings: pulmonary infections after bone marrow transplantation. J Thorac Imaging. 1999;14(3):201–6.

    Article  CAS  PubMed  Google Scholar 

  29. Kaiser L, Huguenin T, Lew PD, Chapuis B, Pittet D. Invasive aspergillosis. Clinical features of 35 proven cases at a single institution. Medicine. 1998;77(3):188–94. https://doi.org/10.1097/00005792-199805000-00004.

    Article  CAS  PubMed  Google Scholar 

  30. Fukuda T, Boeckh M, Guthrie KA, Mattson DK, Owens S, Wald A, et al. Invasive aspergillosis before allogeneic hematopoietic stem cell transplantation: 10-year experience at a single transplant center. Biol Blood Marrow Transplant. 2004;10(7):494–503. https://doi.org/10.1016/j.bbmt.2004.02.006.

    Article  PubMed  Google Scholar 

  31. Kapoor N, Copelan EA, Tutschka PJ. Cytomegalovirus infection in bone marrow transplant recipients: use of intravenous gamma globulin as a prophylactic and therapeutic agent. Transplant Proc. 1989;21(1 Pt 3):3095–6.

    CAS  PubMed  Google Scholar 

  32. Gosselin MV, Adams RH. Pulmonary complications in bone marrow transplantation. J Thorac Imaging. 2002;17(2):132–44. https://doi.org/10.1097/00005382-200204000-00005.

    Article  PubMed  Google Scholar 

  33. Paulin T, Ringden O, Nilsson B, Lonnqvist B, Gahrton G. Variables predicting bacterial and fungal infections after allogeneic marrow engraftment. Transplantation. 1987;43(3):393–8. https://doi.org/10.1097/00007890-198703000-00015.

    Article  CAS  PubMed  Google Scholar 

  34. Choi MH, Jung JI, Chung WD, Kim YJ, Lee SE, Han DH, et al. Acute pulmonary complications in patients with hematologic malignancies. Radiographics. 2014;34(6):1755–68. https://doi.org/10.1148/rg.346130107.

    Article  PubMed  Google Scholar 

  35. Maschmeyer G. Pneumonia in febrile neutropenic patients: radiologic diagnosis. Curr Opin Oncol. 2001;13(4):229–35. https://doi.org/10.1097/00001622-200107000-00004.

    Article  CAS  PubMed  Google Scholar 

  36. Aquino SL, Gamsu G, Webb WR, Kee ST. Tree-in-bud pattern: frequency and significance on thin section CT. J Comput Assist Tomogr. 1996;20(4):594–9. https://doi.org/10.1097/00004728-199607000-00018.

    Article  CAS  PubMed  Google Scholar 

  37. Jung JI, Lee DG, Kim YJ, Yoon HK, Kim CC, Park SH. Pulmonary tuberculosis after hematopoietic stem cell transplantation: radiologic findings. J Thorac Imaging. 2009;24(1):10–6. https://doi.org/10.1097/RTI.0b013e31818c6b97.

    Article  PubMed  Google Scholar 

  38. Navari RM, Sullivan KM, Springmeyer SC, Siegel MS, Meyers JD, Buckner CD, et al. Mycobacterial infections in marrow transplant patients. Transplantation. 1983;36(5):509–13. https://doi.org/10.1097/00007890-198311000-00008.

    Article  CAS  PubMed  Google Scholar 

  39. Mohite U, Das M, Saikia T, Parikh P, Gopal R, Kelkar R, et al. Mycobacterial pulmonary infection post allogeneic bone marrow transplantation. Leuk Lymphoma. 2001;40(5-6):675–8. https://doi.org/10.3109/10428190109097667.

    Article  CAS  PubMed  Google Scholar 

  40. Knoll BM. Update on nontuberculous mycobacterial infections in solid organ and hematopoietic stem cell transplant recipients. Curr Infect Dis Rep. 2014;16(9):421. https://doi.org/10.1007/s11908-014-0421-1.

    Article  CAS  PubMed  Google Scholar 

  41. Doucette K, Fishman JA. Nontuberculous mycobacterial infection in hematopoietic stem cell and solid organ transplant recipients. Clin Infect Dis. 2004;38(10):1428–39. https://doi.org/10.1086/420746.

    Article  PubMed  Google Scholar 

  42. Alangaden GJ, Wahiduzzaman M, Chandrasekar PH, Bone Marrow Transplant G. Aspergillosis: The most common community-acquired pneumonia with gram-negative Bacilli as copathogens in stem cell transplant recipients with graft-versus-host disease. Clin Infect Dis. 2002;35(6):659–64. https://doi.org/10.1086/342061.

    Article  PubMed  Google Scholar 

  43. Bag R. Fungal pneumonias in transplant recipients. Curr Opin Pulm Med. 2003;9(3):193–8. https://doi.org/10.1097/00063198-200305000-00007.

    Article  PubMed  Google Scholar 

  44. Aquino SL, Kee ST, Warnock ML, Gamsu G. Pulmonary aspergillosis: imaging findings with pathologic correlation. AJR Am J Roentgenol. 1994;163(4):811–5. https://doi.org/10.2214/ajr.163.4.8092014.

    Article  CAS  PubMed  Google Scholar 

  45. Gotway MB, Dawn SK, Caoili EM, Reddy GP, Araoz PA, Webb WR. The radiologic spectrum of pulmonary Aspergillus infections. J Comput Assist Tomogr. 2002;26(2):159–73. https://doi.org/10.1097/00004728-200203000-00001.

    Article  PubMed  Google Scholar 

  46. Franquet T, Gimenez A, Hidalgo A. Imaging of opportunistic fungal infections in immunocompromised patient. Eur J Radiol. 2004;51(2):130–8. https://doi.org/10.1016/j.ejrad.2004.03.007.

    Article  PubMed  Google Scholar 

  47. Mori M, Galvin JR, Barloon TJ, Gingrich RD, Stanford W. Fungal pulmonary infections after bone marrow transplantation: evaluation with radiography and CT. Radiology. 1991;178(3):721–6. https://doi.org/10.1148/radiology.178.3.1994408.

    Article  CAS  PubMed  Google Scholar 

  48. Young AY, Leiva Juarez MM, Evans SE. Fungal pneumonia in patients with hematologic malignancy and hematopoietic stem cell transplantation. Clin Chest Med. 2017;38(3):479–91. https://doi.org/10.1016/j.ccm.2017.04.009.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Harrison N, Mitterbauer M, Tobudic S, Kalhs P, Rabitsch W, Greinix H, et al. Incidence and characteristics of invasive fungal diseases in allogeneic hematopoietic stem cell transplant recipients: a retrospective cohort study. BMC Infect Dis. 2015;15:584. https://doi.org/10.1186/s12879-015-1329-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Gregg KS, Kauffman CA. Invasive aspergillosis: epidemiology, clinical aspects, and treatment. Semin Respir Crit Care Med. 2015;36(5):662–72. https://doi.org/10.1055/s-0035-1562893.

    Article  PubMed  Google Scholar 

  51. Denning DW. Early diagnosis of invasive aspergillosis. Lancet. 2000;355(9202):423–4. https://doi.org/10.1016/S0140-6736(00)82003-6.

    Article  CAS  PubMed  Google Scholar 

  52. Kuhlman JE, Fishman EK, Burch PA, Karp JE, Zerhouni EA, Siegelman SS. CT of invasive pulmonary aspergillosis. AJR Am J Roentgenol. 1988;150(5):1015–20. https://doi.org/10.2214/ajr.150.5.1015.

    Article  CAS  PubMed  Google Scholar 

  53. Kuhlman JE, Fishman EK, Siegelman SS. Invasive pulmonary aspergillosis in acute leukemia: characteristic findings on CT, the CT halo sign, and the role of CT in early diagnosis. Radiology. 1985;157(3):611–4. https://doi.org/10.1148/radiology.157.3.3864189.

    Article  CAS  PubMed  Google Scholar 

  54. Curtis AM, Smith GJ, Ravin CE. Air crescent sign of invasive aspergillosis. Radiology. 1979;133(1):17–21. https://doi.org/10.1148/133.1.17.

    Article  CAS  PubMed  Google Scholar 

  55. Gefter WB, Albelda SM, Talbot GH, Gerson SL, Cassileth PA, Miller WT. Invasive pulmonary aspergillosis and acute leukemia. Limitations in the diagnostic utility of the air crescent sign. Radiology. 1985;157(3):605–10. https://doi.org/10.1148/radiology.157.3.4059547.

    Article  CAS  PubMed  Google Scholar 

  56. Franquet T, Muller NL, Gimenez A, Guembe P, de La Torre J, Bague S. Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics. 2001;21(4):825–37. https://doi.org/10.1148/radiographics.21.4.g01jl03825.

    Article  CAS  PubMed  Google Scholar 

  57. Franquet T, Serrano F, Gimenez A, Rodriguez-Arias JM, Puzo C. Necrotizing Aspergillosis of large airways: CT findings in eight patients. J Comput Assist Tomogr. 2002;26(3):342–5. https://doi.org/10.1097/00004728-200205000-00004.

    Article  PubMed  Google Scholar 

  58. Franquet T, Muller NL, Oikonomou A, Flint JD. Aspergillus infection of the airways: computed tomography and pathologic findings. J Comput Assist Tomogr. 2004;28(1):10–6. https://doi.org/10.1097/00004728-200401000-00002.

    Article  PubMed  Google Scholar 

  59. Georgiadou SP, Sipsas NV, Marom EM, Kontoyiannis DP. The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts. Clin Infect Dis. 2011;52(9):1144–55. https://doi.org/10.1093/cid/cir122.

    Article  PubMed  PubMed Central  Google Scholar 

  60. McAdams HP, Rosado de Christenson M, Strollo DC, Patz EF Jr. Pulmonary mucormycosis: radiologic findings in 32 cases. AJR Am J Roentgenol. 1997;168(6):1541–8. https://doi.org/10.2214/ajr.168.6.9168721.

    Article  CAS  PubMed  Google Scholar 

  61. Connolly JE Jr, McAdams HP, Erasmus JJ, Rosado-de-Christenson ML. Opportunistic fungal pneumonia. J Thorac Imaging. 1999;14(1):51–62. https://doi.org/10.1097/00005382-199901000-00005.

    Article  PubMed  Google Scholar 

  62. Alexander BD, Lamoth F, Heussel CP, Prokop CS, Desai SR, Morrissey CO, et al. Guidance on imaging for invasive pulmonary Aspergillosis and Mucormycosis: from the Imaging Working Group for the Revision and Update of the Consensus Definitions of Fungal Disease from the EORTC/MSGERC. Clin Infect Dis. 2021;72(Suppl 2):S79–88. https://doi.org/10.1093/cid/ciaa1855.

    Article  PubMed  Google Scholar 

  63. Sharma S, Nadrous HF, Peters SG, Tefferi A, Litzow MR, Aubry MC, et al. Pulmonary complications in adult blood and marrow transplant recipients: autopsy findings. Chest. 2005;128(3):1385–92. https://doi.org/10.1378/chest.128.3.1385.

    Article  PubMed  Google Scholar 

  64. Buff SJ, McLelland R, Gallis HA, Matthay R, Putman CE. Candida albicans pneumonia: radiographic appearance. AJR Am J Roentgenol. 1982;138(4):645–8. https://doi.org/10.2214/ajr.138.4.645.

    Article  CAS  PubMed  Google Scholar 

  65. Franquet T, Muller NL, Lee KS, Oikonomou A, Flint JD. Pulmonary candidiasis after hematopoietic stem cell transplantation: thin-section CT findings. Radiology. 2005;236(1):332–7. https://doi.org/10.1148/radiol.2361031772.

    Article  PubMed  Google Scholar 

  66. Saito T, Seo S, Kanda Y, Shoji N, Ogasawara T, Murakami J, et al. Early onset Pneumocystis carinii pneumonia after allogeneic peripheral blood stem cell transplantation. Am J Hematol. 2001;67(3):206–9. https://doi.org/10.1002/ajh.1109.

    Article  CAS  PubMed  Google Scholar 

  67. Boiselle PM, Tocino I, Hooley RJ, Pumerantz AS, Selwyn PA, Neklesa VP, et al. Chest radiograph interpretation of Pneumocystis carinii pneumonia, bacterial pneumonia, and pulmonary tuberculosis in HIV-positive patients: accuracy, distinguishing features, and mimics. J Thorac Imaging. 1997;12(1):47–53. https://doi.org/10.1097/00005382-199701000-00007.

    Article  CAS  PubMed  Google Scholar 

  68. Gruden JF, Huang L, Turner J, Webb WR, Merrifield C, Stansell JD, et al. High-resolution CT in the evaluation of clinically suspected Pneumocystis carinii pneumonia in AIDS patients with normal, equivocal, or nonspecific radiographic findings. AJR Am J Roentgenol. 1997;169(4):967–75. https://doi.org/10.2214/ajr.169.4.9308446.

    Article  CAS  PubMed  Google Scholar 

  69. Kanne JP, Yandow DR, Meyer CA. Pneumocystis jiroveci pneumonia: high-resolution CT findings in patients with and without HIV infection. AJR Am J Roentgenol. 2012;198(6):W555–61. https://doi.org/10.2214/AJR.11.7329.

    Article  PubMed  Google Scholar 

  70. Krinzman S, Basgoz N, Kradin R, Shepard JA, Flieder DB, Wright CD, et al. Respiratory syncytial virus-associated infections in adult recipients of solid organ transplants. J Heart Lung Transplant. 1998;17(2):202–10.

    CAS  PubMed  Google Scholar 

  71. Markovic SN, Adlakha A, Smith TF, Walker RC. Respiratory syncytial virus pneumonitis-induced diffuse alveolar damage in an autologous bone marrow transplant recipient. Mayo Clin Proc. 1998;73(2):153–6. https://doi.org/10.1016/S0025-6196(11)63648-3.

    Article  CAS  PubMed  Google Scholar 

  72. Nichols WG, Guthrie KA, Corey L, Boeckh M. Influenza infections after hematopoietic stem cell transplantation: risk factors, mortality, and the effect of antiviral therapy. Clin Infect Dis. 2004;39(9):1300–6. https://doi.org/10.1086/425004.

    Article  PubMed  Google Scholar 

  73. Franquet T. Imaging of pulmonary viral pneumonia. Radiology. 2011;260(1):18–39. https://doi.org/10.1148/radiol.11092149.

    Article  PubMed  Google Scholar 

  74. Franquet T, Lee KS, Muller NL. Thin-section CT findings in 32 immunocompromised patients with cytomegalovirus pneumonia who do not have AIDS. AJR Am J Roentgenol. 2003;181(4):1059–63. https://doi.org/10.2214/ajr.181.4.1811059.

    Article  PubMed  Google Scholar 

  75. Franquet T, Rodriguez S, Martino R, Salinas T, Gimenez A, Hidalgo A. Human metapneumovirus infection in hematopoietic stem cell transplant recipients: high-resolution computed tomography findings. J Comput Assist Tomogr. 2005;29(2):223–7. https://doi.org/10.1097/01.rct.0000157087.14838.4c.

    Article  PubMed  Google Scholar 

  76. Oikonomou A, Muller NL, Nantel S. Radiographic and high-resolution CT findings of influenza virus pneumonia in patients with hematologic malignancies. AJR Am J Roentgenol. 2003;181(2):507–11. https://doi.org/10.2214/ajr.181.2.1810507.

    Article  PubMed  Google Scholar 

  77. Gasparetto EL, Escuissato DL, Marchiori E, Ono S, Frare e Silva RL, Muller NL. High-resolution CT findings of respiratory syncytial virus pneumonia after bone marrow transplantation. AJR Am J Roentgenol. 2004;182(5):1133–7. https://doi.org/10.2214/ajr.182.5.1821133.

    Article  PubMed  Google Scholar 

  78. Foot AB, Caul EO, Roome AP, Darville JM, Oakhill A. Cytomegalovirus pneumonitis and bone marrow transplantation: identification of a specific high risk group. J Clin Pathol. 1993;46(5):415–9. https://doi.org/10.1136/jcp.46.5.415.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Gasparetto EL, Ono SE, Escuissato D, Marchiori E, Roldan L, Marques HL, et al. Cytomegalovirus pneumonia after bone marrow transplantation: high resolution CT findings. Br J Radiol. 2004;77(921):724–7. https://doi.org/10.1259/bjr/70800575.

    Article  CAS  PubMed  Google Scholar 

  80. Kang EY, Patz EF Jr, Muller NL. Cytomegalovirus pneumonia in transplant patients: CT findings. J Comput Assist Tomogr. 1996;20(2):295–9. https://doi.org/10.1097/00004728-199603000-00024.

    Article  CAS  PubMed  Google Scholar 

  81. Franquet T, Muller NL, Gimenez A, Martinez S, Madrid M, Domingo P. Infectious pulmonary nodules in immunocompromised patients: usefulness of computed tomography in predicting their etiology. J Comput Assist Tomogr. 2003;27(4):461–8. https://doi.org/10.1097/00004728-200307000-00001.

    Article  PubMed  Google Scholar 

  82. Daudt LE, Corso MCM, Kerbauy MN, de Assis L, Rechenmacher C, Colturato I, et al. COVID-19 in HSCT recipients: a collaborative study of the Brazilian Society of Marrow Transplantation (SBTMO). Bone Marrow Transplant. 2022;57(3):453–9. https://doi.org/10.1038/s41409-021-01561-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Khurshid I, Anderson LC. Non-infectious pulmonary complications after bone marrow transplantation. Postgrad Med J. 2002;78(919):257–62. https://doi.org/10.1136/pmj.78.919.257.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Evans SE, Ost DE. Pneumonia in the neutropenic cancer patient. Curr Opin Pulm Med. 2015;21(3):260–71. https://doi.org/10.1097/MCP.0000000000000156.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Afessa B, Tefferi A, Litzow MR, Peters SG. Outcome of diffuse alveolar hemorrhage in hematopoietic stem cell transplant recipients. Am J Respir Crit Care Med. 2002;166(10):1364–8. https://doi.org/10.1164/rccm.200208-792OC.

    Article  PubMed  Google Scholar 

  86. Ben-Abraham R, Paret G, Cohen R, Szold O, Cividalli G, Toren A, et al. Diffuse alveolar hemorrhage following allogeneic bone marrow transplantation in children. Chest. 2003;124(2):660–4. https://doi.org/10.1378/chest.124.2.660.

    Article  PubMed  Google Scholar 

  87. Afessa B, Abdulai RM, Kremers WK, Hogan WJ, Litzow MR, Peters SG. Risk factors and outcome of pulmonary complications after autologous hematopoietic stem cell transplant. Chest. 2012;141(2):442–50. https://doi.org/10.1378/chest.10-2889.

    Article  PubMed  Google Scholar 

  88. Schmidt-Wolf I, Schwerdtfeger R, Schwella N, Gallardo J, Schmid HJ, Huhn D, et al. Diffuse pulmonary alveolar hemorrhage after allogeneic bone marrow transplantation. Ann Hematol. 1993;67(3):139–41. https://doi.org/10.1007/BF01701739.

    Article  CAS  PubMed  Google Scholar 

  89. Panoskaltsis-Mortari A, Griese M, Madtes DK, Belperio JA, Haddad IY, Folz RJ, et al. An official American Thoracic Society research statement: noninfectious lung injury after hematopoietic stem cell transplantation: idiopathic pneumonia syndrome. Am J Respir Crit Care Med. 2011;183(9):1262–79. https://doi.org/10.1164/rccm.2007-413ST.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Kantrow SP, Hackman RC, Boeckh M, Myerson D, Crawford SW. Idiopathic pneumonia syndrome: changing spectrum of lung injury after marrow transplantation. Transplantation. 1997;63(8):1079–86. https://doi.org/10.1097/00007890-199704270-00006.

    Article  CAS  PubMed  Google Scholar 

  91. Shankar G, Cohen DA. Idiopathic pneumonia syndrome after bone marrow transplantation: the role of pre-transplant radiation conditioning and local cytokine dysregulation in promoting lung inflammation and fibrosis. Int J Exp Pathol. 2001;82(2):101–13. https://doi.org/10.1111/j.1365-2613.2001.iep0082-0101-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Patriarca F, Skert C, Sperotto A, Damiani D, Cerno M, Geromin A, et al. Incidence, outcome, and risk factors of late-onset noninfectious pulmonary complications after unrelated donor stem cell transplantation. Bone Marrow Transplant. 2004;33(7):751–8. https://doi.org/10.1038/sj.bmt.1704426.

    Article  CAS  PubMed  Google Scholar 

  93. Pandya CM, Soubani AO. Bronchiolitis obliterans following hematopoietic stem cell transplantation: a clinical update. Clin Transplant. 2010;24(3):291–306. https://doi.org/10.1111/j.1399-0012.2009.01122.x.

    Article  PubMed  Google Scholar 

  94. Yoshihara S, Yanik G, Cooke KR, Mineishi S. Bronchiolitis obliterans syndrome (BOS), bronchiolitis obliterans organizing pneumonia (BOOP), and other late-onset noninfectious pulmonary complications following allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2007;13(7):749–59. https://doi.org/10.1016/j.bbmt.2007.05.001.

    Article  PubMed  Google Scholar 

  95. Bergeron A, Cheng GS. Bronchiolitis obliterans syndrome and other late pulmonary complications after allogeneic hematopoietic stem cell transplantation. Clin Chest Med. 2017;38(4):607–21. https://doi.org/10.1016/j.ccm.2017.07.003.

    Article  PubMed  Google Scholar 

  96. Freudenberger TD, Madtes DK, Curtis JR, Cummings P, Storer BE, Hackman RC. Association between acute and chronic graft-versus-host disease and bronchiolitis obliterans organizing pneumonia in recipients of hematopoietic stem cell transplants. Blood. 2003;102(10):3822–8. https://doi.org/10.1182/blood-2002-06-1813.

    Article  CAS  PubMed  Google Scholar 

  97. Kwok WC, Liang BM, Lui MMS, Tam TCC, Sim JPY, Tse EWC, et al. Rapid versus gradual lung function decline in bronchiolitis obliterans syndrome after haematopoietic stem cell transplantation is associated with survival outcome. Respirology. 2019;24(5):459–66. https://doi.org/10.1111/resp.13472.

    Article  PubMed  Google Scholar 

  98. Urbanski SJ, Kossakowska AE, Curtis J, Chan CK, Hutcheon MA, Hyland RH, et al. Idiopathic small airways pathology in patients with graft-versus-host disease following allogeneic bone marrow transplantation. Am J Surg Pathol. 1987;11(12):965–71. https://doi.org/10.1097/00000478-198712000-00007.

    Article  CAS  PubMed  Google Scholar 

  99. Ooi GC, Peh WC, Ip M. High-resolution computed tomography of bronchiolitis obliterans syndrome after bone marrow transplantation. Respiration. 1998;65(3):187–91. https://doi.org/10.1159/000029257.

    Article  CAS  PubMed  Google Scholar 

  100. Winer-Muram HT, Gurney JW, Bozeman PM, Krance RA. Pulmonary complications after bone marrow transplantation. Radiol Clin North Am. 1996;34(1):97–117.

    Article  CAS  PubMed  Google Scholar 

  101. Franquet T, Rodriguez S, Hernandez JM, Martino R, Gimenez A, Hidalgo A, et al. Air-leak syndromes in hematopoietic stem cell transplant recipients with chronic GVHD: high-resolution CT findings. J Thorac Imaging. 2007;22(4):335–40. https://doi.org/10.1097/RTI.0b013e3180cab6cf.

    Article  PubMed  Google Scholar 

  102. Beasley MB. The pathologist’s approach to acute lung injury. Arch Pathol Lab Med. 2010;134(5):719–27. https://doi.org/10.1043/1543-2165-134.5.719.

    Article  PubMed  Google Scholar 

  103. Beasley MB, Franks TJ, Galvin JR, Gochuico B, Travis WD. Acute fibrinous and organizing pneumonia: a histological pattern of lung injury and possible variant of diffuse alveolar damage. Arch Pathol Lab Med. 2002;126(9):1064–70. https://doi.org/10.5858/2002-126-1064-AFAOP.

    Article  PubMed  Google Scholar 

  104. Nguyen LP, Ahdoot S, Sriratanaviriyakul N, Zhang Y, Stollenwerk N, Schivo M, et al. Acute fibrinous and organizing pneumonia associated with allogenic hematopoietic stem cell transplant successfully treated with corticosteroids: a two-patient case series. J Investig Med High Impact Case Rep. 2016;4(2):2324709616643990. https://doi.org/10.1177/2324709616643990.

    Article  PubMed  PubMed Central  Google Scholar 

  105. Lee SM, Park JJ, Sung SH, Kim Y, Lee KE, Mun YC, et al. Acute fibrinous and organizing pneumonia following hematopoietic stem cell transplantation. Korean J Intern Med. 2009;24(2):156–9. https://doi.org/10.3904/kjim.2009.24.2.156.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  106. Simmons GL, Chung HM, McCarty JM, Toor AA, Farkas D, Miller K, et al. Treatment of acute fibrinous organizing pneumonia following hematopoietic cell transplantation with etanercept. Bone Marrow Transplant. 2017;52(1):141–3. https://doi.org/10.1038/bmt.2016.197.

    Article  CAS  PubMed  Google Scholar 

  107. Kligerman SJ, Franks TJ, Galvin JR. From the radiologic pathology archives: organization and fibrosis as a response to lung injury in diffuse alveolar damage, organizing pneumonia, and acute fibrinous and organizing pneumonia. Radiographics. 2013;33(7):1951–75. https://doi.org/10.1148/rg.337130057.

    Article  PubMed  Google Scholar 

  108. Rosenbaum JN, Butt YM, Johnson KA, Meyer K, Batra K, Kanne JP, et al. Pleuroparenchymal fibroelastosis: a pattern of chronic lung injury. Hum Pathol. 2015;46(1):137–46. https://doi.org/10.1016/j.humpath.2014.10.007.

    Article  PubMed  Google Scholar 

  109. Reddy TL, Tominaga M, Hansell DM, von der Thusen J, Rassl D, Parfrey H, et al. Pleuroparenchymal fibroelastosis: a spectrum of histopathological and imaging phenotypes. Eur Respir J. 2012;40(2):377–85. https://doi.org/10.1183/09031936.00165111.

    Article  PubMed  Google Scholar 

  110. Travis WD, Costabel U, Hansell DM, King TE Jr, Lynch DA, Nicholson AG, et al. An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2013;188(6):733–48. https://doi.org/10.1164/rccm.201308-1483ST.

    Article  PubMed  PubMed Central  Google Scholar 

  111. Raghu G, Rochwerg B, Zhang Y, Garcia CA, Azuma A, Behr J, et al. An official ATS/ERS/JRS/ALAT clinical practice guideline: treatment of idiopathic pulmonary fibrosis. An update of the 2011 Clinical Practice Guideline. Am J Respir Crit Care Med. 2015;192(2):e3–19. https://doi.org/10.1164/rccm.201506-1063ST.

    Article  PubMed  Google Scholar 

  112. Astashchanka A, Ryan J, Lin E, Nokes B, Jamieson C, Kligerman S, et al. Pulmonary complications in hematopoietic stem cell transplant recipients—a clinician primer. J Clin Med. 2021;10(15):3227. https://doi.org/10.3390/jcm10153227.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  113. Bondeelle L, Gras J, Michonneau D, Houdouin V, Hermet E, Blin N, et al. Pleuroparenchymal fibroelastosis after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant. 2020;55(5):982–6. https://doi.org/10.1038/s41409-019-0636-8.

    Article  PubMed  Google Scholar 

  114. Mariani F, Gatti B, Rocca A, Bonifazi F, Cavazza A, Fanti S, et al. Pleuroparenchymal fibroelastosis: the prevalence of secondary forms in hematopoietic stem cell and lung transplantation recipients. Diagn Interv Radiol. 2016;22(5):400–6. https://doi.org/10.5152/dir.2016.15516.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Kusagaya H, Nakamura Y, Kono M, Kaida Y, Kuroishi S, Enomoto N, et al. Idiopathic pleuroparenchymal fibroelastosis: consideration of a clinicopathological entity in a series of Japanese patients. BMC Pulm Med. 2012;12:72. https://doi.org/10.1186/1471-2466-12-72.

    Article  PubMed  PubMed Central  Google Scholar 

  116. Frankel SK, Cool CD, Lynch DA, Brown KK. Idiopathic pleuroparenchymal fibroelastosis: description of a novel clinicopathologic entity. Chest. 2004;126(6):2007–13. https://doi.org/10.1378/chest.126.6.2007.

    Article  PubMed  Google Scholar 

  117. Pegoraro F, Favre C. Post-transplantation lymphoproliferative disorder after haematopoietic stem cell transplantation. Ann Hematol. 2021;100(4):865–78. https://doi.org/10.1007/s00277-021-04433-y.

    Article  PubMed  Google Scholar 

  118. Ru Y, Zhang X, Song T, Ding Y, Zhu Z, Fan Y, et al. Epstein-Barr virus reactivation after allogeneic hematopoietic stem cell transplantation: multifactorial impact on transplant outcomes. Bone Marrow Transplant. 2020;55(9):1754–62. https://doi.org/10.1038/s41409-020-0831-7.

    Article  CAS  PubMed  Google Scholar 

  119. Halkos ME, Miller JI, Mann KP, Miller DL, Gal AA. Thoracic presentations of posttransplant lymphoproliferative disorders. Chest. 2004;126(6):2013–20. https://doi.org/10.1378/chest.126.6.2013.

    Article  PubMed  Google Scholar 

  120. Carignan S, Staples CA, Muller NL. Intrathoracic lymphoproliferative disorders in the immunocompromised patient: CT findings. Radiology. 1995;197(1):53–8. https://doi.org/10.1148/radiology.197.1.7568853.

    Article  CAS  PubMed  Google Scholar 

  121. Dodd GD 3rd, Ledesma-Medina J, Baron RL, Fuhrman CR. Posttransplant lymphoproliferative disorder: intrathoracic manifestations. Radiology. 1992;184(1):65–9. https://doi.org/10.1148/radiology.184.1.1609104.

    Article  PubMed  Google Scholar 

  122. Collins J, Muller NL, Leung AN, McGuinness G, Mergo PJ, Flint JD, et al. Epstein-Barr-virus-associated lymphoproliferative disease of the lung: CT and histologic findings. Radiology. 1998;208(3):749–59. https://doi.org/10.1148/radiology.208.3.9722856.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tomás Franquet .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Franquet, T., Giménez, A., Mazzini, S. (2023). Pulmonary Complications Following Hematopoietic Stem Cell Transplantation: Radiological Considerations. In: Soubani, A.O. (eds) Pulmonary and Critical Care Considerations of Hematopoietic Stem Cell Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-031-28797-8_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-28797-8_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-28796-1

  • Online ISBN: 978-3-031-28797-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics