Korean J Radiol.  2004 Jun;5(2):107-113. 10.3348/kjr.2004.5.2.107.

Bronchiolitis Obliterans after Allogenic Bone Marrow Transplantation: HRCT Findings

• Jung JI
• Jung WS
• Hahn ST
• Min CK
• Kim CC
• Park SH

• KMID: 753990
• DOI: http://doi.org/10.3348/kjr.2004.5.2.107

Abstract

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.

Keyword

Bone marrow, transplantation; Bronchiolitis obliterans; Computed tomography (CT), high-resolution

MeSH Terms

Adult
Bone Marrow Transplantation/*adverse effects
Bronchiolitis Obliterans/diagnosis/*etiology/*radiography
Bronchography
Female
Human
Lung/radiography
Male
*Tomography, X-Ray Computed
Transplantation, Homologous

Figure

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  Fig. 1 A 24-year-old woman with bronchiolitis obliterans. She underwent allogeneic bone marrow transplantation for chronic myelocytic leukemia approximately 11 months previously. Inspiratory high resolution computed tomography at the time of diagnosis of bronchiolitis obliterans shows diffuse hypoattenuation and thin-walled dilated bronchi (white arrows) in both lower

• 

  Fig. 2 A 29-year-old man with bronchiolitis obliterans. He underwent allogeneic bone marrow transplantation for chronic myelocytic leukemia approximately one year previously. A. Inspiratory high resolution computed tomography shows diffuse decreased lung attenuation. The pulmonary vessels are sparse and attenuated in the region of decreased density (arrows). B. Expiratory scan shows air trapping within the diseased region (arrows). C. Photomicrograph (elastic van Gieson stain, ×200) shows narrowing of bronchial lumen due to fibrosis of the lamina propria, surrounded by an elastic bundle (arrows) (from Journal of Thoracic Imaging 2001;16:130-37 "notes from 2000 annual meeting of Korean Society of Thoracic Radiology" with permission).

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  Fig. 3 Tree-in-buds of bronchiolitis obliterans in a 28-year-old woman. Bronchiolitis obliterans was diagnosed on spirometry and transbronchial lung biopsy 16 months after bone marrow transplantation for chronic myelocytic leukemia. Inspiratory high resolution computed tomography scan shows decreased lung attenuation and subsegmental bronchial dilatations in left lower lobe. Tree-in-bud pattern is noted in subpleural portion of posterior basal segment of left lower lobe (arrow).

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  Fig. 4 Progression of bronchiolitis obliterans on high resolution computed tomography in a 28-year-old woman. Bronchiolitis obliterans was diagnosed on spirometry and transbronchial lung biopsy 16 months after bone marrow transplantation for chronic myelocytic leukemia. A. Inspiratory high resolution computed tomography scan at the time of diagnosis of bronchiolitis obliterans shows small areas of decreased lung attenuation in both upper lobes (arrows). B. Inspiratory high resolution computed tomography scan taken nine months later at a similar anatomic level to A, shows markedly increased extent of pulmonary hypoattenuation and new development of subsegmental bronchial dilatations. The lung volume is much increased.

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