PMC8349085_01
Chest Imaging: A) Lung images from abdominal CT scan (prior to liver transplant) with ground glass opacities in the lower lobes; (B) Chest CT (8 months post-liver transplant) with lower lobe subpleural septal thickening, new ground-glass opacities and scattered subpleural cysts; and (C) chest CT (28 months post-liver transplant) with progressive, diffuse subpleural reticulations with traction bronchiectasis more prominent in the lower lobes.
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A review of pre-liver transplant abdominal CT demonstrated lower lobe ground glass opacities (Fig. 1A) that compared to current chest CT revealed new lingular opacities and bilateral subpleural septal thickening (Fig. 1B). Follow-up chest CT (Fig. 1C) demonstrated increased subpleural reticulations with lower lobe traction bronchiectasis compared to the earlier chest CT images.
Surgical lung biopsy of lower lobe. A. Advanced interstitial fibrosis with peripheral accentuation causing architectural distortion. There is mucostasis (arrowhead) associated with bronchiectasis and extension to the alveolar parenchyma (H&E, original magnification 20x). B. Fibroblastic focus (arrow) consists of fibroblasts and myofibroblasts, covered by metaplastic epithelium (arrowhead) (H&E, original magnification 200x).
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Subsequently, a thoracoscopic surgical lung biopsy of the left upper and lower lobes was performed and lung histopathology confirmed a diagnosis of usual interstitial pneumonitis (Fig. 2).