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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.

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.

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.

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).

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).

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.

FIGURE 98-7

Miliary pattern of hematogenous tuberculosis dissemination seen as very small nodules (thus the name of miliary ...

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