Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ INFECTIONS ++ Transplant patients (mostly due to their immunosuppression) are susceptible to a wide spectrum of both local and systemic infectious complications In the first postoperative month, like in the nonimmunosuppressed postoperative population, there is a predominance of nosocomial infections Opportunistic infections usually occur during the second to the sixth months after transplantation, when immunosuppression levels are high Although imaging findings may at times be suggestive of certain diagnoses, there is considerable overlap and biopsies are necessary until proven otherwise +++ LUNG INFECTIONS +++ Aspergillus (Figures 98-1 and 98-2) ++ FIGURE 98-1 Angioinvasive aspergillosis. Forty-nine-year-old man who presented 97 days after transplantation with fevers. Coned-down view of right lung shows a rounded paramediastinal mass surrounded by a haze of ground glass (so-called “halo sign”) representing perilesional hemorrhage. Graphic Jump LocationView Full Size||Download Slide (.ppt) ++ FIGURE 98-2 Subsequent scan after clinical improvement shows incipient cavitation with a classic “crescent sign”. This is the typical appearance of an angioinvasive mycotic (particularly aspergillus) infection. Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ Cryptococcus (Figure 98-3) ++ FIGURE 98-3 Forty-eight-year-old women 91-day posttransplantation. Coned-down axial view of right lung shows a soft-tissue opacity surrounded by a thin ground glass halo. Blood and bronchoalveolar lavage cultures were positive for Cryptococcus neoformans. Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ Ground Glass Opacities [Cytomegalovirus (CMV) and Pneumocystis] (Figures 98-4 and 98-5) ++ FIGURE 98-4 Two examples of diffuse ground glass pulmonary opacities. Both cases were in immunosuppressed transplant patients with complaints of fevers and cough. The ground glass opacities in Figure 98-4, patchy and geographic in distribution, proved to be cytomegalovirus. The ground glass opacities in Figure 98-5, diffuse and with preservation of the mantle, are suggestive (although not diagnostic) of Pneumocystis jirovecii (as was subsequently proved in this case). Graphic Jump LocationView Full Size||Download Slide (.ppt) ++ FIGURE 98-5 Two examples of diffuse ground glass pulmonary opacities. Both cases were in immunosuppressed transplant patients with complaints of fevers and cough. The ground glass opacities in Figure 98-4, patchy and geographic in distribution, proved to be cytomegalovirus. The ground glass opacities in Figure 98-5, diffuse and with preservation of the mantle, are suggestive (although not diagnostic) of Pneumocystis jirovecii (as was subsequently proved in this case). Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ Tuberculosis (TB) (Figures 98-6 and 98-7) ++ FIGURE 98-6 Tubular branching opacities featuring a tree-in-bud appearance. This pattern is quite typical of endobronchial disseminated tuberculosis. Graphic Jump LocationView Full Size||Download Slide (.ppt) ++ FIGURE 98-7 Miliary pattern of hematogenous tuberculosis dissemination seen as very small nodules (thus the name of miliary ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth