PMC2742173_01
PMC2742173_02
Graphic representation of spirometry data in months after transplant. At three months since her transplant, she received pulse steroids after a negative lavage and transbronchial biopsies. At 6 months after transplant, she received a course of empiric antibiotics after a lavage. She underwent open lung biopsy at 10 months after transplantation. At 12 months she underwent pericardiectomy.
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F1
Her spirometry continued to deteriorate (figure 1) and she underwent repeat BAL and transbronchial biopsies which showed no evidence of infection, rejection or recurrent lymphangioleiomyomatosis.
PMC2742173_03
Chest CT one-year after lung transplantation without lung parenchymal abnormalities but with bilateral pleural effusions and new pericardial thickening.
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F2
Chest CT (figure 2) demonstrated new thickening of the pericardium.
Cardiac catheterization tracing of simultaneous left and right heart pressures. Note classic "square-root sign" characteristic of constrictive pericarditis. The tracing reveals equalization of right and left ventricular diastolic pressures and evidence for ventricular interdependence during inspiration and expiration.
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F3
Simultaneous right and left heart catheterization confirmed constrictive physiology, with equalization of right and left ventricular diastolic pressures and evidence for ventricular interdependence during inspiration and expiration (figure 3).