PMC6330790_01
(a) Preoperative chest radiograph showing bilateral extensive reticulonodular opacities obscuring cardiac borders. (b) Preoperative high-resolution computed tomography scan of the chest showing bilateral intra and interlobular septal thickening, patchy areas of consolidation, ground glass opacities, and presence of variable-sized cysts
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F1
A 33-year-old female with a diagnosis of chronic hypersensitivity pneumonitis presented with progressively increasing dyspnea [Figure 1].
PMC6330790_02
(a) Chest radiograph on the first postoperative day showing bilateral diffuse alveolar opacities. (b) Chest radiograph 12 days after transplantation showing partial clearing of the alveolar opacities. (c) Chest radiograph 14 days after transplantation showing reappearance of extensive bilateral alveolar opacities. Evidence of air collection within the subcutaneous soft tissue can also be noted at both sides of the chest
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F2
She continued to require FiO2 of 0.4 for 24 h after the surgery, and the chest radiograph revealed the bilateral diffuse alveolar opacities [Figure 2a]. Intravenous fosfomycin (8 g every 8 h) was added, and intrapleural irrigation was performed with colistin (0.5 million units in each pleural cavity every 12 h) that resulted in partial clearing of the lung opacities [Figure 2b]. However, postoperatively, the patient continued to deteriorate with increasing alveolar opacities and evidence of subcutaneous air collection on chest radiograph [Figure 2c].