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British Journal of Radiology (2003) 76, 373-379
© 2003 British Institute of Radiology
doi: 10.1259/bjr/66835905
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Pulmonary complications following bone marrow transplantation

T M Wah, FRCR1, H A Moss, MRCP, FRCR1, R J H Robertson, MRCP, FRCR1 and D L Barnard, FRCP, FRCPath2

1 Department of Clinical Radiology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX and 2 Department of Clinical Haematology, St. James's University Hospital, Beckett Street, Leeds LS9 7TF, UK



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  		Figure 1. (a) Angioinvasive aspergillosis pneumonia diagnosed on bronchoscopy in a 22-year-old man with acute myeloid leukaemia and prolonged neutropenia following bone marrow transplantation. Chest radiograph shows a cavitating right upper lobe mass and left pleural effusion. (b) High resolution CT of the same patient at the time of 1a, shows an "air-crescent sign" due to cavitation of the pulmonary nodule. This occurred about 3 weeks after the appearance of the nodules and indicates that the neutropenia is recovering.

 


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  		Figure 2. (a) 66-year-old man with acute myeloid leukaemia who had prolonged neutropenia following bone marrow transplantation. Chest radiograph shows multiple micronodules secondary to candida infection. (b) High resolution CT of the same patient shows multiple micronodules with surrounding ground glass (arrow), also known as the "CT halo sign" that represents haemorrhagic infarction around the consolidated fungal infection.

 


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  		Figure 3. High resolution CT in a patient with cytomegalovirus pneumonitis and oesophagitis, shows bilateral upper lobe ground glass changes with cavitation of the left upper lobe consolidation and air in the mediastinum.

 


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  		Figure 4. Cytomegalovirus pneumonia in a 47-year-old man with chronic myeloid leukaemia following bone marrow transplantation. High resolution CT shows areas of consolidation in both lower lobes, patchy ground glass attenuation and multiple micronodules.

 


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  		Figure 5. 65-year-old man with multiple myeloma and prolonged neutropenia. High resolution CT shows characteristic appearances of Pneumocystis carinii pneumonia: diffuse bilateral and symmetrical perihilar ground glass attenuation.

 


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  		Figure 6. High resolution CT (HRCT) of a patient with systemic graft versus host disease (GVHD) HRCT shows mild bronchial dilatation, bronchial wall thickening, peripheral vascular pruning and areas of patchy lung attenuation with air trapping. Appearances suggest obliterative bronchiolitis in GVHD.

 




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