Potentialities of high-resolution computed tomography in diagnosis of pulmonary lesions after bone marrow transplantation in blood diseases


Cite item

Full Text

Abstract

Aim. To study characteristics of a skialogical picture of pulmonary parenchyma and roentgenomorphological signs of inflammatory changes before and after bone marrow transplantation (BMT); relationship between the data of high-resolution computed tomography (HRCT) and clinical data. Material and methods. HRCT (computer tomograph of the third generation "Somatom CR-3") was made in fever, changes in physical examination in patients (n = 28) after BMTfrom November 200] to January 2003. BMT was made in myelomic disease, lymphogranulomatosis, acute leukemia, chronic myeloid leukemia, lymphosarcoma, autoimmune hemolytic anemia.
Results. Twenty four patients were examined before BMT. Of them, 18 patients had roentgenomorphological changes of the parenchyma, primarily, diffuse. Three patients were examined during conditioning, two cases had signs of toxic pulmonitis. One day after allo-BMT all the patients exhibited lowering of densitometric values of pulmonary tissue by 70 HU vs the baseline. Infectious affection of the lungs was diagnosed in 13 cases during day 0-100. From day 100 after allo-BMT 7 recipients were observed. In 6 cases the changes resulted from transplant against host reaction. Infectious affection of pulmonary tissue was observed in 1 case. Characteristic x-ray picture of pulmonary stroma In secondary disease was determined.
Conclusion. For early diagnosis of pneumonia in myelotoxic agranulocytosis it is necessary to make examination by HRCT before BMT. HRCT of the chest is indicated in even minor changes in the clinical picture. It is necessary to perform a control over water-electrolyte balance and active respiratory exercise in the course of conditioning. Viral pneumonias show the picture of metainflammatory changes for a long time. Fungal pneumonias tend to recurrence at "previous site". HRCT examination of the pulmonary tissue provides more information about pulmonary tissue in patients with secondary disease.

References

  1. Leung A. N, Gosselin М. V., Napper С. Н. et al. Pulmonary infection after bone marrow transplantation: Clinical and radiographic findings. Radiology 1999; 210: 699-710.
  2. Савченко В. Г., Паровичникова Е. Н., Любимова Л. С., Менделеева Л. П. Трансплантация костного мозга при острых лейкозах: аргументы за и против. Тер. арх. 1993; 7: 7-18.
  3. Менделеева Л. П. и др. Эффективность высокодозной химиотерапии и трансплантации аутологичных гемопоэтических клеток при лимфогранулематозе. Там же 2000; 7: 32-37.
  4. Любимова Л. С., Савченко В. Г., Менделеева Л. П. и др. Эффективность трансплантации аллогенного костного мозга у больных острым лейкозом в фазе полной ремиссии. Там же 1999; 7: 27-32.
  5. Krowka M. J., Kosenow E. С., Haagland H. С. Pulmonary complication of bone marrow transplantation. Chest 1985; 87: 237-246.
  6. Janzen D. L., Paslty S. P. G., Adler B. D., Muller N. L. Acute pulmonary complications in immunocompromissed non-AIDS patients: Comparison of diagnostic accuracy of CT and cyest radiography. Clin. Radiol. 1993; 47: 159-165.
  7. Тюрин И. Е. КТ высокого разрешения в диагностике заболеваний органов дыхания. Мед. визуализ. 1999; 3: 36-44.
  8. Юдин А. Л., Афанасьева Н. И., Абович Ю. А., Романова Е. А. Лучевая диагностика инфильтративных заболеваний легких (обзор). Радиология-практика 2000; 10: 10-17.
  9. Suster В., Akerman M., Orenstein M. et al. Pulmonary manifestations of AIDS: Review of 106 episodes. Radiology 1986; 161: 87-93.
  10. Fanfulla F., Pedrazzoli P., Da Prada G. A. et al. Pulmonary function and complications following chemotherapy and stem cell support in breast cancer. Eur. Respir. J. 2000; 15: 56-61.
  11. Freundlich I. M., Bragg D. G. A radiologic approach to diseases of the chest. 2-nd ed. Baltimore 1997.
  12. Kuhlman E. A., Kavuru M., Fishman E. K. et al. Pneumocystis carinii pneumonia: Spectrum of parenchymal CT findings. Radiology 1990; 174:711-714.
  13. Bergin С. J., Wirth R. L., Berry G. J. et al. Pneumocystis carinii pneumonia: CT and HRCT observations. J. Comput. Assist. Tomogr. 1990; 15: 756-759.
  14. Hertz M. I., Englund J. A., Snover D. et al. Respiratory syncytial virus-induced acute lung injury in adult patients with bone marrow transplants: A clinical approach and review of the literature. Medicine (Baltimore) 1989; 68: 269-281.
  15. Olliff J. F. C., Williams M. P. Radiological appearances of cytomegalovirus infections. Clin. Radiol. 1989; 40: 463-467.
  16. Schulman L. L. Cytomegalovirus pneumonitis and lobar consolidation. Chest 1989; 152: 749-752.
  17. Kroboth F. J., Yu V. L., Reddy S. C. et al. Clinicoradiographic correlation with the extent of legionnaire disease. Am. J. Roentgenol. 1983; 141: 263-268.
  18. Huang R. M., Naidich D. P., Lubat E. et al. Septic pulmonary emboli: CT-radiographic correlation. Ibid. 1989; 153: 41-54.
  19. Kuhlman J. E., Fishman E. K, Siegelman S. S. Invasive pulmonary aspergillosis in acute leukemia: characteristic findings on CT, the CT halo sign, and the role of CT in early diagnosis. Radiology 1985; 157: 611-614.
  20. Kuhlman J. E., Fishman E. K., Burch P. A. et al. CT of invasive pulmonary aspergillosis. Am. J. Roentgenol. 1988; 150: 1015-1020.
  21. Primach S. L., Hartman T. E., Lee K. S., Muller N. L. Pulmonary nodules and the CT halo sign. Radiology 1994; 190: 513-515.
  22. Calvin J. R., D'Alessandro M. P. The diagnosis of diffuse lung disease.
  23. Гриппи М. А. Патофизиология легких. М.: Binom Publishers; 2000. 111-112.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2004 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

 © 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies