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Non-infectious manifestations of stem cell transplantation

Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK

View larger version (164K): [in a new window]   Figure 1. Marrow signal change following stem cell transplantation. T1 weighted MRI sequence of the cervical spine demonstrates diffuse increase in the marrow signal reflecting the increase in yellow marrow seen following high dose irradiation therapy.

View larger version (91K): [in a new window]   Figure 2. Routine follow up CT in a 29-year-old male following autologous stem cell transplant taken at the level of sacroiliac joints. Bilateral lucencies with a narrow zone of transition are demonstrated within both posterior iliac wings from trephine marrow aspiration.

View larger version (89K): [in a new window]   Figure 3. Avascular necrosis. 35-year-old female with bilateral hip pain at 1 year following a matched unrelated transplant. The patient had recently completed a course of steroids for an episode of GVHD. (a) Coronal T1 weighted MRI image of the hips and (b) sagittal T1 weighted MRI of the left hip showing a serpiginous zone of low signal around the avascular area (arrow).

View larger version (124K): [in a new window]   Figure 4. Axial CT of the head through the level of the lateral ventricles. An area of high attenuation is seen within the left thalamus demonstrating a thalamic haemorrhage. A minor degree of cortical atrophy within the frontal lobes is shown.

View larger version (109K): [in a new window]   Figure 5. Biopsy proven squamous cell carcinoma of the roof of the mouth in a 39-year-old female, 8 years following stem cell transplantation. Contrast enhanced axial CT through the roof of the oral cavity. A heterogeneous mass involving the roof of the mouth adherent to the alveolar aspects of the maxilla is demonstrated (arrows). There was no evidence of bony destruction.

View larger version (72K): [in a new window]   Figure 6. Diffuse alveolar haemorrhage. (a) Chest radiograph taken 22 days following allogeneic SCT shows bilateral alveolar opacification. (b) CT from a different patient with dyspnoea taken at 29 days following transplantation demonstrates patchy ground glass attenuation within the mid zones.

View larger version (115K): [in a new window]   Figure 7. Bronchiolitis obliterans. High resolution CT shows decreased pulmonary vasculature and subsegmental bronchial dilatation (asterisk). Obvious areas of air trapping giving the "mosaic perfusion" appearance are not readily apparent. (Image courtesy of Dr J Reynolds. Consultant Radiologist at Heartlands and Solihul Hospital, Birmingham.)

View larger version (81K): [in a new window]   Figure 8. Organizing pneumonia. 32-year-old male with increasing breathlessness at 5 months following stem cell transplantation. (a) Chest radiograph demonstrates upper zone, peripheral areas of consolidation and interstitial shadowing. (b) CT demonstrates areas of ill defined ground glass attenuation in association with more focal areas of consolidation in a predominantly subpleural distribution. (Images courtesy of Dr J Reynolds. Consultant Radiologist at Heartlands and Solihul Hospital, Birmingham.)

View larger version (62K): [in a new window]   Figure 9. Lymphocytic interstitial pneumonitis. 33-year-old male with increasing breathlessness 3 months following stem cell transplantation. (a) Chest radiograph demonstrates bilateral mid and lower zone pulmonary nodules measuring 1–5 mm in the absence of clinical infection. (b) High resolution CT through the lower lobes demonstrates widespread nodules throughout the lungs and patchy ground glass opacification. (Images courtesy of Dr J Reynolds. Consultant Radiologist at Heartlands and Solihul Hospital, Birmingham.)

View larger version (71K): [in a new window]   Figure 10. A misplaced single lumen central venous catheter. (a) The tip is seen to lie within the left axillary vein (arrow). (b) Using a common femoral vein approach the tip is snared and manipulated into the correct position. (Images courtesy of Dr P Crowe. Consultant Radiologist at Heartlands and Solihul Hospital, Birmingham.)

View larger version (81K): [in a new window]   Figure 11. A snare catheter via a femoral vein approach may be used to strip the tip of a central venous catheter when a fibrin sheath is seen to overlie the tip. (Image courtesy of Dr P Crowe. Consultant Radiologist at Heartlands and Solihul Hospital, Birmingham.)

View larger version (122K): [in a new window]   Figure 12. Neutropenic colitis. 28-year-old male with abdominal pain. CT with oral contrast through the level of the caecum in a neutropenic patient. There is marked thickening of the caecum (arrows) and descending colon. The caecal pole is dilated and there is streaking of the mesenteric and retroperitoneal fat planes.