MDCT Evaluation of Early Pulmonary Infection Types After Liver Transplantation K. Hekimoglua,*, S. Tezcana, M. Coskuna, M.I. Dogrulb, G. Morayc, and M. Haberalc Departments of aRadiology, bPulmonary Diseases, and cSurgery, Baskent University, School of Medicine, Ankara, Turkey
ABSTRACT Introduction. Opportunistic pulmonary infections frequently occur after liver transplantation, and affect mortality and morbidity significantly. The purpose of this study was to define the incidence, types, and imaging characteristics of pulmonary infections in liver transplant recipients with multidetector CT (MDCT) evaluation. Methods. Thirty-five adult transplant recipients diagnosed with a pulmonary infection within the first 45 days posttransplantation were reviewed retrospectively from March 2002 to December 2013. MDCT features were evaluated retrospectively by 2 radiologists in consensus. All diagnoses were made by sputum analysis, cultures, biopsies, and postmortem histopathologic evaluation. Results. Pneumococcus pneumonia was found in 7 patients. Five patients had nonspecific pneumonia, Candidiasis, Klebsiella, and Aspergillosis separately. S aureus pneumonia was detected in 2 patients and the other 2 patients had Escherichia coli pneumonia. Two patients had active tuberculosis and 1 patient had Acinetobacter pneumonia also. Four main MDCT patterns were identified: patchy infiltrations (10%), tree-in-bud pattern (9.5%), ground-glass opacity (8.5%), and nodules with halo sign (6%). One patient had a cavitary lesion owing to tuberculosis. Conclusion. Although the incidence of pulmonary complications in liver recipients was relatively low, mortality from serious infections was high. Care must be taken with pulmonary infectious complications in the posttransplant period. For any suspicious case, MDCT evaluation for specific patterns of early accurate diagnosis is very important.
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EPATIC TRANSPLANTATIONS are being performed with increasing frequency and are highly successful treatments for patients with end-stage liver disease and acute liver failure. Despite advances in posttransplant care, infections remain the most important complication after liver transplantation. Pulmonary infections are the most frequent source of early postoperative infection, and significantly affect mortality and morbidity of liver transplant recipients [1]. Prolonged hospitalization and mechanical ventilation after transplantation are associated with an increased risk for bacterial, viral, and fungal pulmonary infections. Increased immunosuppressive treatment to prevent rejection process is another factor that contributes to infections [2,3]. Early and correct diagnosis of pulmonary infections is very important, especially in the postoperative period. Today, serious pulmonary infections are followed up with multidetector CT (MDCT). Specific imaging patterns of pulmonary infections
ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
Transplantation Proceedings, 47, 473e477 (2015)
are becoming important for early diagnosis. Most pulmonary infections have specific infiltration patterns and locations on MDCT images. Specific MDCT imaging patterns of pulmonary infections in early posttransplant period have not been exactly defined previously. The purpose of the study was to evaluate retrospectively and determine the specific MDCT imaging patterns of early pulmonary infections in liver transplant recipients. MATERIALS AND METHODS Liver transplantation has been performed in our hospital since January 1999. Radiologic follow-up includes routine postoperative chest *Address correspondence to Koray Hekimoglu, MD, Baskent Universitesi Hastanesi, Radyoloji ABD, Fevzi Cakmak Cad. 10. sok. No: 45, Bahcelievler, Ankara 06490 Turkey. E-mail: [email protected] 0041-1345/15 http://dx.doi.org/10.1016/j.transproceed.2014.12.028
473
474
Fig 1. Rates of each infection patterns of pulmonary infections in transplant recipients represented graphically. radiographs followed by CT if any parenchymal abnormality was detected on serial chest radiography. A next-generation MDCT scanner with 16 slice capability was installed and put into use in March 2002 (Somatom Sensation 16, Siemens Medical Solutions, Erlangen, Germany). All hepatic recipients were evaluated and followed for any suspicious pulmonary complication with this MDCT scanner. In this retrospective study, we evaluated medical records and MDCT images of transplant recipients diagnosed with early pulmonary infections (
ABSTRACT Introduction. Opportunistic pulmonary infections frequently occur after liver transplantation, and affect mortality and morbidity significantly. The purpose of this study was to define the incidence, types, and imaging characteristics of pulmonary infections in liver transplant recipients with multidetector CT (MDCT) evaluation. Methods. Thirty-five adult transplant recipients diagnosed with a pulmonary infection within the first 45 days posttransplantation were reviewed retrospectively from March 2002 to December 2013. MDCT features were evaluated retrospectively by 2 radiologists in consensus. All diagnoses were made by sputum analysis, cultures, biopsies, and postmortem histopathologic evaluation. Results. Pneumococcus pneumonia was found in 7 patients. Five patients had nonspecific pneumonia, Candidiasis, Klebsiella, and Aspergillosis separately. S aureus pneumonia was detected in 2 patients and the other 2 patients had Escherichia coli pneumonia. Two patients had active tuberculosis and 1 patient had Acinetobacter pneumonia also. Four main MDCT patterns were identified: patchy infiltrations (10%), tree-in-bud pattern (9.5%), ground-glass opacity (8.5%), and nodules with halo sign (6%). One patient had a cavitary lesion owing to tuberculosis. Conclusion. Although the incidence of pulmonary complications in liver recipients was relatively low, mortality from serious infections was high. Care must be taken with pulmonary infectious complications in the posttransplant period. For any suspicious case, MDCT evaluation for specific patterns of early accurate diagnosis is very important.
H
EPATIC TRANSPLANTATIONS are being performed with increasing frequency and are highly successful treatments for patients with end-stage liver disease and acute liver failure. Despite advances in posttransplant care, infections remain the most important complication after liver transplantation. Pulmonary infections are the most frequent source of early postoperative infection, and significantly affect mortality and morbidity of liver transplant recipients [1]. Prolonged hospitalization and mechanical ventilation after transplantation are associated with an increased risk for bacterial, viral, and fungal pulmonary infections. Increased immunosuppressive treatment to prevent rejection process is another factor that contributes to infections [2,3]. Early and correct diagnosis of pulmonary infections is very important, especially in the postoperative period. Today, serious pulmonary infections are followed up with multidetector CT (MDCT). Specific imaging patterns of pulmonary infections
ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
Transplantation Proceedings, 47, 473e477 (2015)
are becoming important for early diagnosis. Most pulmonary infections have specific infiltration patterns and locations on MDCT images. Specific MDCT imaging patterns of pulmonary infections in early posttransplant period have not been exactly defined previously. The purpose of the study was to evaluate retrospectively and determine the specific MDCT imaging patterns of early pulmonary infections in liver transplant recipients. MATERIALS AND METHODS Liver transplantation has been performed in our hospital since January 1999. Radiologic follow-up includes routine postoperative chest *Address correspondence to Koray Hekimoglu, MD, Baskent Universitesi Hastanesi, Radyoloji ABD, Fevzi Cakmak Cad. 10. sok. No: 45, Bahcelievler, Ankara 06490 Turkey. E-mail: [email protected] 0041-1345/15 http://dx.doi.org/10.1016/j.transproceed.2014.12.028
473
474
Fig 1. Rates of each infection patterns of pulmonary infections in transplant recipients represented graphically. radiographs followed by CT if any parenchymal abnormality was detected on serial chest radiography. A next-generation MDCT scanner with 16 slice capability was installed and put into use in March 2002 (Somatom Sensation 16, Siemens Medical Solutions, Erlangen, Germany). All hepatic recipients were evaluated and followed for any suspicious pulmonary complication with this MDCT scanner. In this retrospective study, we evaluated medical records and MDCT images of transplant recipients diagnosed with early pulmonary infections (
