Posterior reversible encephalopathy syndrome (PRES) is usually a reversible clinical and radiological entity associated with typical features on brain MR or CT imaging. However, the not-so-uncommon atypical radiological presentations of the condition are also present and they may go unrecognised as they are confused with other conditions. Here, we report a very rare case of atypical, unilateral PRES in a 49-year-old uremic, post-transplant female patient who presented with seizures. Initial MRI showed high-grade occlusion of the left middle cerebral artery (MCA) and lesions suggestive of subacute infarction in the ipsilateral frontotemporoparietal lobe. Patient symptoms had resolved a day after the onset without any specific treatment but early follow-up CT findings suggested hemorrhagic transformation. Follow-up MRI performed 2 years later showed complete disappearence of the lesions and persisting MCA occlusion.
Acute Kidney Injury/complications ; Brain/radiography ; Diagnosis, Differential ; Female ; Humans ; Infarction, Middle Cerebral Artery/diagnosis/radiography ; Lung Transplantation ; Magnetic Resonance Imaging ; Middle Aged ; Posterior Leukoencephalopathy Syndrome/complications/*diagnosis ; Tomography, X-Ray Computed

Micropigs are the most likely source animals for xenotransplantation. However, an appropriate method for evaluating the lung of micropigs had not been established. Therefore, this study was performed to evaluate the feasibility of 64-channel multi-detector row computed tomography (MDCT) to measure the diameter of the pulmonary arteries and the lung volume in micropigs. The mean diameters of the trachea, and left and right bronchi were 1.6 +/- 0.17, 1.18 +/- 0.14, and 1.1 +/- 0.11 cm, respectively. The mean diameters of the main, right, and left pulmonary arteries were 1.38 +/- 0.09, 1.07 +/- 0.26, and 0.98 +/- 0.13 cm and the diameters of right, left, and common inferior pulmonary veins were 0.97 +/- 0.20, 0.76 +/- 0.20, and 1.99 +/- 0.26 cm, respectively. The mean lung volume was 820.3 +/- 77.11 mL. The data presented in this study suggest that the MDCT may be a noninvasive, rapid, and accurate investigational method for pulmonary anatomy in living lung donors.
Animals ; Humans ; Lung/physiology/*radiography ; Organ Size/physiology ; Pulmonary Artery/physiology/*radiography ; Swine ; Swine, Miniature/*anatomy & histology ; Tomography, X-Ray Computed/*methods ; Transplantation, Heterologous/*methods

A 60-year-old man presented with cough, sputum, and dyspnea. He had a history of acute myeloid leukemia and hematopoietic stem cell transplantation with chronic renal failure. Chest CT scans showed miliary nodules and patchy consolidations. Histological examination revealed numerous fibrin balls within the alveoli and thickening of the alveolar septum, both of which are typical pathological features of acute fibrinous and organizing pneumonia (AFOP). We report the first case of AFOP following allogeneic hematopoietic stem cell transplantation.
Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Biopsy ; Cryptogenic Organizing Pneumonia/etiology/pathology ; Fatal Outcome ; Glucocorticoids/administration & dosage ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Hemoptysis/etiology ; Humans ; Leukemia, Myeloid, Acute/*surgery ; Lung Diseases/*etiology/pathology ; Male ; Middle Aged ; Pleural Effusion/etiology ; Pulse Therapy, Drug ; Radiography, Thoracic ; Respiratory Insufficiency/etiology ; Tomography, X-Ray Computed

Blood Gas Analysis ; Echocardiography ; Hepatopulmonary Syndrome ; diagnosis ; physiopathology ; therapy ; Humans ; Hypoxia ; diagnosis ; etiology ; therapy ; Liver Cirrhosis ; complications ; Liver Transplantation ; Lung ; pathology ; physiopathology ; Oxygen ; therapeutic use ; Radiography, Thoracic ; Respiratory Function Tests

OBJECTIVE: To describe the pulmonary complications following hematopoietic stem cell transplantation (HSCT) that can present with a "crazy-paving" pattern in high-resolution CT scans. MATERIALS AND METHODS: Retrospective review of medical records from 2,537 patients who underwent HSCT. The "crazy-paving" pattern consists of interlobular and intralobular septal thickening superimposed on an area of ground-glass attenuation on high-resolution CT scans. The CT scans were retrospectively reviewed by two radiologists, who reached final decisions by consensus. RESULTS: We identified 10 cases (2.02%), seven male and three female, with pulmonary complications following HSCT that presented with the "crazy-paving" pattern. Seven (70%) patients had infectious pneumonia (adenovirus, herpes simplex, influenza virus, cytomegalovirus, respiratory syncytial virus, and toxoplasmosis), and three patients presented with non-infectious complications (idiopathic pneumonia syndrome and acute pulmonary edema). The "crazy-paving" pattern was bilateral in all cases, with diffuse distribution in nine patients (90%), predominantly in the middle and inferior lung regions in seven patients (70%), and involving the anterior and posterior regions of the lungs in nine patients (90%). CONCLUSION: The "crazy-paving" pattern is rare in HSCT recipients with pulmonary complications and is associated with infectious complications more commonly than non-infectious conditions.
Adolescent ; Adult ; Female ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Humans ; Lung/*radiography ; Lung Diseases/etiology/*radiography ; Male ; Middle Aged ; Pneumonia/etiology/radiography ; Pulmonary Edema/etiology/radiography ; Respiratory Tract Infections/etiology/radiography ; *Tomography, X-Ray Computed ; Young Adult

OBJECTIVE: To evaluate the high resolution computed tomography (HRCT) findings of bronchiolitis obliterans (BO) after bone marrow transplantation (BMT). MATERIALS AND METHODS: During the past three years, 11 patients were diagnosed as having BO after BMT when they developed irreversible air flow obstruction, with an FEV1 value of less than 80% of the baseline value, without any clinical evidence of infection. All 11 patients underwent HRCT, of whom eight also underwent follow-up HRCT. The HRCT images were assessed retrospectively for the presence of decreased lung attenuation, segmental or subsegmental bronchial dilatation, diminution of peripheral vascularity, centrilobular nodules, and branching linear structure on the inspiratory images. The lobar distribution of the decreased lung attenuation and bronchial dilatation was also examined. The presence of air trapping was investigated on the expiratory images. The interval changes of the HRCT findings were evaluated in those patients who had follow-up images. RESULTS: Abnormal HRCT findings were present in all cases; the most common abnormalities were decreased lung attenuation (n=11), subsegmental bronchial dilatation (n=6), diminution of peripheral vascularity (n=6), centrilobular nodules or branching linear structure (n=3), and segmental bronchial dilatation (n=3). Expiratory air trapping was noted in all patients. The decreased lung attenuation and bronchial dilatations were more frequent or extensive in the lower lobes. Interval changes were found in all patients with follow-up HRCT: increased extent of decreased lung attenuation (n=7) ; newly developed or progressed bronchial dilatation (n=4) ; and increased lung volume (n=3). CONCLUSION: HRCT scans are abnormal in patients with BO, with the most commonly observed finding being areas of decreased lung attenuation. While the HRCT findings are not specific, it is believed that their common features can assist in the diagnosis of BO in BMT recipients.
Adult ; Bone Marrow Transplantation/*adverse effects ; Bronchiolitis Obliterans/diagnosis/*etiology/*radiography ; Bronchography ; Female ; Human ; Lung/radiography ; Male ; *Tomography, X-Ray Computed ; Transplantation, Homologous

Cytomegalovirus (CMV) pneumonia is one of the major causes of morbidity and mortality in immunocompromised patients such as transplant recipients. But CMV pneumonia is unusually reported among adults with leukemia who have not undergone transplantation. Because it is a cause of life-threatening pneumonia in adults with leukemia receiving potent immunosuppressive therapies, CMV has emerged as an important pathogen. We report a case of CMV pneumonia and invasive pulmonary aspergillosis in a patient with acute leukemia who have not undergone transplantation. A 31-year-old man with acute myelogenous leukemia developed high fever on day 9 of second consolidation chemotherapy. Six days later, chest radiography showed patchy consolidation with central cavity on right upper lung. Considering fungal pneumonia, amphoterin B was started, then fever was subsided. Chest CT showed necrotizing pneumonia with cavity formation in posterior segment of right upper lobe. Because of several episodes of hemoptysis, lobectomy was performed. Grossly, the area of focal necrosis with central cavity formation and multiple small interstitial nodules were observed. In the area of interstitial nodules, giant cells with intranuclear inclusion and perinuclear halo were found. In the area of focal necrosis, fungal hyphae with acute branching and septation were found. Ganciclovir and immunoglobulin were administered for CMV pneumonia. On day 62 of the chemotherapy, the patient discharged with improved symptoms. After several weeks, unrelated HLA-matched allogeneic stem cell transplantation was performed. On day 14 of transplantation, the patient died due to septic shock of unknown cause.
Adult ; Aspergillosis ; Consolidation Chemotherapy ; Cytomegalovirus* ; Drug Therapy* ; Fever ; Ganciclovir ; Giant Cells ; Hemoptysis ; HMGB1 Protein ; Humans* ; Hyphae ; Immunocompromised Host ; Immunoglobulins ; Intranuclear Inclusion Bodies ; Invasive Pulmonary Aspergillosis ; Leukemia ; Leukemia, Myeloid, Acute* ; Lung ; Mortality ; Necrosis ; Pneumonia* ; Pulmonary Aspergillosis* ; Radiography ; Shock, Septic ; Stem Cell Transplantation ; Thorax ; Tomography, X-Ray Computed ; Transplantation

The immunosuppression significantly increases the risk for acquiring opportunistic infections due to bacteria, viruses, fungi, and protozoa. These opportunistic infections are the major source of morbidity and mortality in transplanted patients. Cytomegalovirus and Aspergillus are important infectious agents in renal transplant recipients. The onset of these diseases follows the period of maximal immunosuppression for the prevention and treatment of acute rejection. Cytomegalovirus infection can suppressed immunity in renal transplant recipient and associated with other opportunistic infections. We experienced a case of Aspergillus and Cytomegalovirus pneumonia after renal transplantation. This 45-year-old woman had undergone renal transplantation. About 1 months later, she presented with dry cough and mild fever. Chest radiographs revealed multifocal patchy and conglomerated consolidation on both lung field, especially lower lung field. The invasive aspergillosis and cytomegalovirus pneumonia was diagnosed by open lung biopsy. Her condition was progressively aggravated despite amphotericin B and ganciclovir therapy and expired 53 days after renal transplantation.
Amphotericin B ; Aspergillosis ; Aspergillus ; Bacteria ; Biopsy ; Cough ; Cytomegalovirus Infections ; Cytomegalovirus* ; Female ; Fever ; Fungi ; Ganciclovir ; Humans ; Immunosuppression ; Kidney Transplantation* ; Lung ; Middle Aged ; Mortality ; Opportunistic Infections ; Pneumonia* ; Radiography, Thoracic ; Transplantation

Legionella species are causative agents of both community-acquired and nosocomial pneumonia. The spectrum of disease ranges from asymptomatic infection to serious disease and two specific syndromes are identified, i.e., Legionnaires' disease and Pontiac fever. Legionnaires' disease tends to occur in patients with underlying illnesses, so Legionella pneumonia should be included in the differential diagnosis of severe community-acquired pneumonia, especially in immunocompromised patients. Herein we report a case of community- acquired Legionnaires' disease in a patient with renal transplantation. A 63-year old man was admitted because of fever, chills, and dyspnea. Thirteen years ago, he had undergone kidney transplantation and he had received immu-nosuppressive agents, including deflazacort and cyclosporin A. On physical examination crackles were heard in the middle area of the right lung and the chest radiograph showed multifocal patchy consolidations on both lung fields. Serologic tests for Legionella pneumophila antibody, urinary antigen assay for L. pneumophila serogroup 1, and polymerase chain reaction for Legionella DNA fragments (5S rRNA, IPC, mip target sequence) were positive. The patient was treated with roxithromycin for twenty eight days and recovered without complication.
Asymptomatic Infections ; Chills ; Cyclosporine ; Diagnosis, Differential ; DNA ; Dyspnea ; Fever ; Humans ; Immunocompromised Host ; Kidney Transplantation ; Legionella ; Legionella pneumophila ; Legionnaires' Disease* ; Lung ; Middle Aged ; Physical Examination ; Pneumonia ; Polymerase Chain Reaction ; Radiography, Thoracic ; Respiratory Sounds ; Roxithromycin ; Serologic Tests ; Transplantation*

Case 1: A 39-year-old man underwent orthotopic heart transplantation on November 1994 for dilated cardiomyopathy. His postoperative course was unevenful and medications included daily cyclosporin A, Immuran and prednisone. On December 13.1994, he developed cough and sore throat. Chest radiographs revealed multiple patch growing lesions. Sputum fungus culture revealed Aspergillus Fumigatus. The patient was treated with daily infusion of amphotericin B. He remains well without evidence of relapse of Aspergillus, Case 2: This 39-year-old man had undergone orthotopic heart transplantation on November 16 1994 for dilated cardiomyopathy. In December 7.1994. he developed recurrent syncope. Chest radiographs revealed fungus ball like lesion on right lung field. On open lung biopsy and wedge resection of the mass was performed. Aspergillosis and CMV infection was demonstrated in the biopsy specimen. The patient was treated with conventional amphotericin B therapy for over 7weeks and Ganciclovir for over 2weeks. At the end of therapy chest X-ray showed only small residual scar in the area of previous mass.
Adult ; Amphotericin B ; Aspergillosis* ; Aspergillus ; Aspergillus fumigatus ; Azathioprine ; Biopsy ; Cardiomyopathy, Dilated ; Cicatrix ; Cough ; Cyclosporine ; Fungi ; Ganciclovir ; Heart Transplantation* ; Heart* ; Humans ; Lung ; Pharyngitis ; Prednisone ; Radiography, Thoracic ; Recurrence ; Sputum ; Syncope ; Thorax