Skip to main content
Top
Published in: European Radiology 9/2014

01-09-2014 | Chest

Pulmonary nodules and masses in lung transplant recipients: clinical and CT findings

Authors: Olivier Morla, Renan Liberge, Pierre Paul Arrigoni, Eric Frampas

Published in: European Radiology | Issue 9/2014

Login to get access

Abstract

Objectives

The purpose of this study was to review the clinical and CT findings of pulmonary nodules and masses in lung transplant recipients and to determine distinguishing features among the various aetiologies.

Methods

This retrospective study included 106 lung transplant recipients who had a chest CT performed over a 7-year period in a single institution.

Results

Twenty-four cases of pulmonary nodules and masses were observed on CT. Among the single lesions, three (50 %) were due to infections, one (17 %) to organizing pneumonia, and two (33 %) remained of undetermined origin. Among the multiple lesions, 14 (78 %) were due to infection, three to post-transplant lymphoproliferative disorder (17 %), and one to bronchogenic carcinoma (5 %). The two main microorganisms were P. aeruginosa and Aspergillus spp. Among 12 solid nodules > 1 cm, four (33 %) were due to malignancy: three post-transplant lymphoproliferative disorders (25 %), and one bronchogenic carcinoma (8 %). Among five cavitary nodules four (80 %) were due to aspergillosis.

Conclusion

Infection is the most frequent aetiology of pulmonary nodules and masses in lung transplant recipients, but other causes such as post-transplant lymphoproliferative disorder, bronchogenic carcinoma, or organizing pneumonia should be considered.

Key points

Pulmonary nodules and masses are frequent in lung transplant recipients.
Infection is the most frequent aetiology of solitary and multiple pulmonary nodules.
Differential diagnosis includes post-transplant lymphoproliferative disorder, bronchogenic carcinoma, and organizing pneumonia.
Clinical and CT findings are often non-specific.
CT findings may be suggestive of some aetiologies that justify a biopsy.
Literature
1.
go back to reference Toronto Lung Transplant Group (1986) Unilateral lung transplantation for pulmonary fibrosis. N Engl J Med 314(18):1140–1145CrossRef Toronto Lung Transplant Group (1986) Unilateral lung transplantation for pulmonary fibrosis. N Engl J Med 314(18):1140–1145CrossRef
2.
go back to reference Registry of the International Society for Heart and Lung Transplantation 2012. J Heart Lung Transplant. October 2012; 31 (10): 1045–1095 Registry of the International Society for Heart and Lung Transplantation 2012. J Heart Lung Transplant. October 2012; 31 (10): 1045–1095
3.
go back to reference Lee P, Minai OA, Mehta AC, DeCamp MM, Murthy S (2004) Pulmonary nodules in lung transplant recipients: etiology and outcome. Chest 125(1):165–172PubMedCrossRef Lee P, Minai OA, Mehta AC, DeCamp MM, Murthy S (2004) Pulmonary nodules in lung transplant recipients: etiology and outcome. Chest 125(1):165–172PubMedCrossRef
4.
go back to reference Schulman LL, Htun T, Staniloae C, McGregor CC, Austin JH (2000) Pulmonary nodules and masses after lung and heart-lung transplantation. J Thorac Imaging 15(3):173–179PubMedCrossRef Schulman LL, Htun T, Staniloae C, McGregor CC, Austin JH (2000) Pulmonary nodules and masses after lung and heart-lung transplantation. J Thorac Imaging 15(3):173–179PubMedCrossRef
5.
go back to reference End A, Helbich T, Wisser W, Dekaan G, Klepetko W (1995) The pulmonary nodule after lung transplantation: cause and outcome. Chest 107(5):1317–1322PubMedCrossRef End A, Helbich T, Wisser W, Dekaan G, Klepetko W (1995) The pulmonary nodule after lung transplantation: cause and outcome. Chest 107(5):1317–1322PubMedCrossRef
6.
go back to reference Girvin F, Ko J (2008) P, “Pulmonary nodules: Detection, assessment, and CAD,”. AJR Am J Roentgenol 191(4):1057–1069PubMedCrossRef Girvin F, Ko J (2008) P, “Pulmonary nodules: Detection, assessment, and CAD,”. AJR Am J Roentgenol 191(4):1057–1069PubMedCrossRef
7.
go back to reference MacMahon H, Austin JHM, Gamsu G et al (2005) Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 237(2):395–400PubMedCrossRef MacMahon H, Austin JHM, Gamsu G et al (2005) Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 237(2):395–400PubMedCrossRef
8.
go back to reference Aguilar-Guisado M, Givaldá J, Ussetti P et al (2007) Pneumonia after lung transplantation in the RESITRA Cohort: a multicenter prospective study. Am J Transplant 7(8):1989–1996PubMedCrossRef Aguilar-Guisado M, Givaldá J, Ussetti P et al (2007) Pneumonia after lung transplantation in the RESITRA Cohort: a multicenter prospective study. Am J Transplant 7(8):1989–1996PubMedCrossRef
9.
go back to reference Collins J, Müller NL, Kazerooni EA, Paciocco G (2000) CT findings of pneumonia after lung transplantation. AJR Am J Roentgenol 175(3):811–818PubMedCrossRef Collins J, Müller NL, Kazerooni EA, Paciocco G (2000) CT findings of pneumonia after lung transplantation. AJR Am J Roentgenol 175(3):811–818PubMedCrossRef
10.
go back to reference Nunley DR, Grgurich W, Iacono AT et al (1998) Allograft colonization and infections with pseudomonas in cystic fibrosis lung transplant recipients. Chest mai 113(5):1235–1243CrossRef Nunley DR, Grgurich W, Iacono AT et al (1998) Allograft colonization and infections with pseudomonas in cystic fibrosis lung transplant recipients. Chest mai 113(5):1235–1243CrossRef
11.
go back to reference Judson MA (1993) Clinical aspects of lung transplantation. Clin Chest Med 14(2):335–357PubMed Judson MA (1993) Clinical aspects of lung transplantation. Clin Chest Med 14(2):335–357PubMed
12.
go back to reference Dauber JH, Paradis IL, Dummer JS (1990) Infectious complications in allograft recipients. Clin Chest Med 11(2):291–308PubMed Dauber JH, Paradis IL, Dummer JS (1990) Infectious complications in allograft recipients. Clin Chest Med 11(2):291–308PubMed
13.
go back to reference Singh N, Husain S (2003) Aspergillus infections after lung transplantation: clinical differences in type of transplant and implications for management. J Heart Lung Transplant 22(3):258–266PubMedCrossRef Singh N, Husain S (2003) Aspergillus infections after lung transplantation: clinical differences in type of transplant and implications for management. J Heart Lung Transplant 22(3):258–266PubMedCrossRef
14.
go back to reference De Pauw B, Walsh TJ, Donnelly JP et al (2008) Revised Definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 46(12):1813–1821PubMedCentralPubMedCrossRef De Pauw B, Walsh TJ, Donnelly JP et al (2008) Revised Definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 46(12):1813–1821PubMedCentralPubMedCrossRef
15.
go back to reference Kuhlman JE, Fishman EK, Siegelman SS (1985) Invasive pulmonary aspergillosis in acute leukemia: characteristic findings on CT, the CT halo sign, and the role of CT in early diagnosis. Radiology 157(3):611–614PubMedCrossRef Kuhlman JE, Fishman EK, Siegelman SS (1985) Invasive pulmonary aspergillosis in acute leukemia: characteristic findings on CT, the CT halo sign, and the role of CT in early diagnosis. Radiology 157(3):611–614PubMedCrossRef
16.
go back to reference Ettinger NA, Bailey TC, Trulock EP et al (1993) Cytomegalovirus infection and pneumonitis. Impact after isolated lung transplantation. Washington University Lung Transplant Group. Am Rev Respir Dis 147(4):1017–1023PubMedCrossRef Ettinger NA, Bailey TC, Trulock EP et al (1993) Cytomegalovirus infection and pneumonitis. Impact after isolated lung transplantation. Washington University Lung Transplant Group. Am Rev Respir Dis 147(4):1017–1023PubMedCrossRef
17.
go back to reference Fishman JA, Rubin RH (1998) Infection in organ-transplant recipients. N Engl J Med 338(24):1741–1751PubMedCrossRef Fishman JA, Rubin RH (1998) Infection in organ-transplant recipients. N Engl J Med 338(24):1741–1751PubMedCrossRef
18.
go back to reference Martin M (1994) Combination antiviral strategies in managing cytomegalovirus infection. Transplant Proc 26(5) Suppl 1:28-30 Martin M (1994) Combination antiviral strategies in managing cytomegalovirus infection. Transplant Proc 26(5) Suppl 1:28-30
19.
go back to reference Ho M (1994) Advances in understanding cytomegalovirus infection after transplantation. Transplant Proc 26(5) Suppl 1:7-11 Ho M (1994) Advances in understanding cytomegalovirus infection after transplantation. Transplant Proc 26(5) Suppl 1:7-11
20.
go back to reference Bonser RS, Fragomeni LS, Jamieson SW (1989) Heart-lung transplantation. Invest Radiol 24(4):310–322PubMedCrossRef Bonser RS, Fragomeni LS, Jamieson SW (1989) Heart-lung transplantation. Invest Radiol 24(4):310–322PubMedCrossRef
21.
go back to reference Wreghitt TG, Hakim M, Gray JJ, Kucia S, Wallwork J, English TA (1988) Cytomegalovirus infections in heart and heart and lung transplant recipients. J Clin Pathol 41(6):660–667PubMedCentralPubMedCrossRef Wreghitt TG, Hakim M, Gray JJ, Kucia S, Wallwork J, English TA (1988) Cytomegalovirus infections in heart and heart and lung transplant recipients. J Clin Pathol 41(6):660–667PubMedCentralPubMedCrossRef
22.
go back to reference Shreeniwas R, Schulman LL, Berkmen YM, McGregor CC, Austin JHM (1996) Opportunistic bronchopulmonary infections after lung transplantation: clinical and radiographic findings. Radiology 200(2):349–356PubMedCrossRef Shreeniwas R, Schulman LL, Berkmen YM, McGregor CC, Austin JHM (1996) Opportunistic bronchopulmonary infections after lung transplantation: clinical and radiographic findings. Radiology 200(2):349–356PubMedCrossRef
23.
go back to reference Kang EY, Patz EF Jr, Müller NL et al (1996) Cytomegalovirus pneumonia in transplant patients: CT findings. J Comput Assist Tomogr 20(2):295–299PubMedCrossRef Kang EY, Patz EF Jr, Müller NL et al (1996) Cytomegalovirus pneumonia in transplant patients: CT findings. J Comput Assist Tomogr 20(2):295–299PubMedCrossRef
24.
go back to reference Harris NL, Swerdlow SH, Frizzera G, Knowles DM. Post-transplant lymphoproliferative disorders. In: Jaffe ES, Harris NL, Stein H, Vardiman JW, eds. World Health Organization classification of tumours: pathology and genetics of tumours of haematopoietic and lymphoid tissues. Lyon, France : IARC, 2001; 264–9 Harris NL, Swerdlow SH, Frizzera G, Knowles DM. Post-transplant lymphoproliferative disorders. In: Jaffe ES, Harris NL, Stein H, Vardiman JW, eds. World Health Organization classification of tumours: pathology and genetics of tumours of haematopoietic and lymphoid tissues. Lyon, France : IARC, 2001; 264–9
25.
go back to reference Walker RC, Marshall WF, Strickler JG et al (1995) Pretransplantation assessment of the risk of lymphoproliferative disorder. Clin Infect Dis 20(5):1346–1353PubMedCrossRef Walker RC, Marshall WF, Strickler JG et al (1995) Pretransplantation assessment of the risk of lymphoproliferative disorder. Clin Infect Dis 20(5):1346–1353PubMedCrossRef
26.
go back to reference Kremer BE, Reshef R, Misleh JG et al (2012) Post-transplant lymphoproliferative disorder after lung transplantation: a review of 35 cases. J Heart Lung Transplant 31(3):296–304PubMedCrossRef Kremer BE, Reshef R, Misleh JG et al (2012) Post-transplant lymphoproliferative disorder after lung transplantation: a review of 35 cases. J Heart Lung Transplant 31(3):296–304PubMedCrossRef
27.
go back to reference Reams BD, McAdams HP, Howell DN, Steele MP, Davis RD, Palmer SM (2003) Posttransplant lymphoproliferative disorder: incidence, presentation, and response to treatment in lung transplant recipients. Chest 124(4):1242–1249PubMedCrossRef Reams BD, McAdams HP, Howell DN, Steele MP, Davis RD, Palmer SM (2003) Posttransplant lymphoproliferative disorder: incidence, presentation, and response to treatment in lung transplant recipients. Chest 124(4):1242–1249PubMedCrossRef
28.
go back to reference Bakker NA, van Imhoff GW, Verschuuren EA, van Son WJ (2007) Presentation and early detection of posttransplant lymphoproliferative disorder after solid organ transplantation. Transpl Int 20(3):207–218PubMedCrossRef Bakker NA, van Imhoff GW, Verschuuren EA, van Son WJ (2007) Presentation and early detection of posttransplant lymphoproliferative disorder after solid organ transplantation. Transpl Int 20(3):207–218PubMedCrossRef
29.
go back to reference Bragg DG, Chor PJ, Murray KA, Kjeldsberg CR (1994) Lymphoproliferative disorders of the lung: histopathology, clinical manifestations, and imaging features. AJR Am J Roentgenol 163(2):273–281PubMedCrossRef Bragg DG, Chor PJ, Murray KA, Kjeldsberg CR (1994) Lymphoproliferative disorders of the lung: histopathology, clinical manifestations, and imaging features. AJR Am J Roentgenol 163(2):273–281PubMedCrossRef
30.
go back to reference Borhani AA, Hosseinzadeh K, Almusa O, Furlan A, Nalesnik M (2009) Imaging of posttransplantation lymphoproliferative disorder after solid organ transplantation. Radiographics 29(4):981–1000PubMedCrossRef Borhani AA, Hosseinzadeh K, Almusa O, Furlan A, Nalesnik M (2009) Imaging of posttransplantation lymphoproliferative disorder after solid organ transplantation. Radiographics 29(4):981–1000PubMedCrossRef
31.
go back to reference Loren AW, Tsai DE (2005) Post-transplant lymphoproliferative disorder. Clin Chest Med 26(4):631–645, viiPubMedCrossRef Loren AW, Tsai DE (2005) Post-transplant lymphoproliferative disorder. Clin Chest Med 26(4):631–645, viiPubMedCrossRef
32.
go back to reference Siegel MJ, Lee EY, Sweet SC, Hildebolt C (2003) CT of posttransplantation lymphoproliferative disorder in pediatric recipients of lung allograft. AJR Am J Roentgenol 181(4):1125–1131PubMedCrossRef Siegel MJ, Lee EY, Sweet SC, Hildebolt C (2003) CT of posttransplantation lymphoproliferative disorder in pediatric recipients of lung allograft. AJR Am J Roentgenol 181(4):1125–1131PubMedCrossRef
33.
go back to reference Dodd GD III, Ledesma-Medina J, Baron RL et al (1992) Posttransplant lymphoproliferative disorder: intrathoracic manifestations. Radiology 184(1):65–69PubMedCrossRef Dodd GD III, Ledesma-Medina J, Baron RL et al (1992) Posttransplant lymphoproliferative disorder: intrathoracic manifestations. Radiology 184(1):65–69PubMedCrossRef
34.
go back to reference Marom EM, McAdams HP, Butnor KJ, Coleman RE (2004) Positron emission tomography with fluoro-2-deoxy-D-glucose (FDG-PET) in the staging of post transplant lymphoproliferative disorder in lung transplant recipients. J Thorac Imaging 19(2):74–78PubMedCrossRef Marom EM, McAdams HP, Butnor KJ, Coleman RE (2004) Positron emission tomography with fluoro-2-deoxy-D-glucose (FDG-PET) in the staging of post transplant lymphoproliferative disorder in lung transplant recipients. J Thorac Imaging 19(2):74–78PubMedCrossRef
35.
go back to reference Cook RC, Connors JM, Gascoyne RD, Fradet G, Levy RD (1999) Treatment of post-transplant lymphoproliferative disease with rituximab monoclonal antibody after lung transplantation. Lancet 354(9191):1698–1699PubMedCrossRef Cook RC, Connors JM, Gascoyne RD, Fradet G, Levy RD (1999) Treatment of post-transplant lymphoproliferative disease with rituximab monoclonal antibody after lung transplantation. Lancet 354(9191):1698–1699PubMedCrossRef
36.
go back to reference Collins J, Kazerooni E A, Lacomis J et al (2002)Bronchogenic carcinoma after lung transplantation: frequency, clinical characteristics, and imaging findings. Radiology 224131–138.138 Collins J, Kazerooni E A, Lacomis J et al (2002)Bronchogenic carcinoma after lung transplantation: frequency, clinical characteristics, and imaging findings. Radiology 224131–138.138
37.
go back to reference Choi YH, Leung AN, Miro S, Poirier C, Hunt S, Theodore J (2000) Primary bronchogenic carcinoma after heart or lung transplantation: radiologic and clinical findings. J Thorac Imaging 15(1):36–40PubMedCrossRef Choi YH, Leung AN, Miro S, Poirier C, Hunt S, Theodore J (2000) Primary bronchogenic carcinoma after heart or lung transplantation: radiologic and clinical findings. J Thorac Imaging 15(1):36–40PubMedCrossRef
38.
go back to reference Chaparro C, Chamberlain D, Maurer J, Winton T, Dehoyos A, Kesten S (1996) Bronchiolitis Obliterans Organizing Pneumonia (BOOP) in Lung Transplant Recipients. Chest 110(5):1150–1154PubMedCrossRef Chaparro C, Chamberlain D, Maurer J, Winton T, Dehoyos A, Kesten S (1996) Bronchiolitis Obliterans Organizing Pneumonia (BOOP) in Lung Transplant Recipients. Chest 110(5):1150–1154PubMedCrossRef
39.
go back to reference Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN (2008) Bronchiolitis obliterans organizing pneumonia: Pathogenesis, clinical features, imaging and therapy review. Ann Thorac Med 3(2):67–75PubMedCrossRef Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN (2008) Bronchiolitis obliterans organizing pneumonia: Pathogenesis, clinical features, imaging and therapy review. Ann Thorac Med 3(2):67–75PubMedCrossRef
40.
go back to reference Lee KS, Kullnig P, Hartman TE, Müller NL (1994) Cryptogenic organizing pneumonia: CT findings in 43 patients. AJR American Journal of Roentgenol 162(3):543–546CrossRef Lee KS, Kullnig P, Hartman TE, Müller NL (1994) Cryptogenic organizing pneumonia: CT findings in 43 patients. AJR American Journal of Roentgenol 162(3):543–546CrossRef
41.
go back to reference Bouchardy LM, Kuhlman JE, Ball WC Jr, Hruban RH, Askin FB, Siegelman SS (1993) CT findings in bronchiolitis obliterans organizing pneumonia (BOOP) with radiographic, clinical, and histologic correlation. J Comput Assist Tomogr 17(3):352–357PubMedCrossRef Bouchardy LM, Kuhlman JE, Ball WC Jr, Hruban RH, Askin FB, Siegelman SS (1993) CT findings in bronchiolitis obliterans organizing pneumonia (BOOP) with radiographic, clinical, and histologic correlation. J Comput Assist Tomogr 17(3):352–357PubMedCrossRef
42.
go back to reference Akira M, Yamamoto S, Sakatani M (1998) Bronchiolitis obliterans organizing pneumonia manifesting as multiple large nodules or masses. AJR American Journal of Roentgenol 170(2):291–295CrossRef Akira M, Yamamoto S, Sakatani M (1998) Bronchiolitis obliterans organizing pneumonia manifesting as multiple large nodules or masses. AJR American Journal of Roentgenol 170(2):291–295CrossRef
43.
go back to reference Domingo JA, Calvo JIP, Carretero JA et al (1993) Bronchiolitis obliterans organizing pneumonia: an unusual cause of solitary pulmonary nodule. Chest 103(5):1621–1623PubMedCrossRef Domingo JA, Calvo JIP, Carretero JA et al (1993) Bronchiolitis obliterans organizing pneumonia: an unusual cause of solitary pulmonary nodule. Chest 103(5):1621–1623PubMedCrossRef
44.
go back to reference Kim SJ, Lee KS, Ryu YH et al (2003) Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. AJR Am J Roentgenol mai 180(5):1251–1254CrossRef Kim SJ, Lee KS, Ryu YH et al (2003) Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. AJR Am J Roentgenol mai 180(5):1251–1254CrossRef
45.
go back to reference Wingard JR, Hiemenz JW, Jantz MA (2012) How I manage pulmonary nodular lesions and nodular infiltrates in patients with hematologic malignancies or undergoing hematopoietic cell transplantation. Blood 120:1791–1800PubMedCrossRef Wingard JR, Hiemenz JW, Jantz MA (2012) How I manage pulmonary nodular lesions and nodular infiltrates in patients with hematologic malignancies or undergoing hematopoietic cell transplantation. Blood 120:1791–1800PubMedCrossRef
Metadata
Title
Pulmonary nodules and masses in lung transplant recipients: clinical and CT findings
Authors
Olivier Morla
Renan Liberge
Pierre Paul Arrigoni
Eric Frampas
Publication date
01-09-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3264-0

Other articles of this Issue 9/2014

European Radiology 9/2014 Go to the issue