PMC9112311_01
Date: 11-2018: Transverse (left) and coronal (right) views of chest computed
tomographic (CT) scan showing scattered ground glass opacities (GGO) in the
lung bases bilaterally and mild diffuse bronchiectasis in all lobes, as
first radiological changes after both hematopoietic stem cell
transplants.
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In November 2018, he presented to the clinic for dyspnea and nonproductive cough, for which a computed tomographic (CT) scan of the chest was done and showed scattered ground glass opacities (GGO) in the lung bases bilaterally and mild diffuse bronchiectasis in all lobes (Figure 1). His pulmonary function test (PFT) also showed further significant drop in his FEV1, and to a greater extent, his FVC (Figure 1).
Date 03-2019: Follow-up chest computed tomographic (CT) scan showing (Left:
Transverse view; Right: Coronal view) progression of the bilateral lower to
mid lobe predominant, peripheral and peribronchovascular consolidations with
worsening traction bronchiectasis and evidence of a new architectural
distortion. These changes were previously visualized, only 4 months earlier,
as scattered ground glass abnormalities with a milder form of diffuse
traction, as shown in Figure 1.
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A repeat CT scan of the chest showed development of new lower lobe predominant bilateral, peripheral, peribronchovascular consolidations in the areas of previously seen GGOs, with worsening traction bronchiectasis and evidence of a new architectural distortion (Figure 2), and a suspicion of organizing pneumonia was raised in the radiology report, with a suggestion of chronic pulmonary GVHD, and less likely infection or medication side effect.
Date 05-2019: Follow-up chest computed tomographic (CT) scan, transverse
view, showing the appearance of the first pulmonary cystic changes (white
arrows) in bilateral upper lobes, with associated mild traction
bronchiectasis (black arrowheads) suggestive of a fibrosing and progressive
pulmonary pathology.
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A new CT scan of the chest showed further worsening in bilateral, mid-lung predominant consolidations and ground glass opacities, with changes of traction bronchiectasis and appearance of new cystic changes (Figure 3).
Date: 08-2020: Transverse (Left) and Coronal (Right) of chest computed
tomographic (CT) scan, done 14 months after the second transplant, and
showing severe upper and mid-lung zones predominant bronchiectatic changes
in peri-bronchovascular and peripheral distribution, along with bilateral
and extensive upper lobe predominant cysts. The significant decrease in
ground glass opacities visualized on previous imaging is indicative of the
decrease in inflammatory component of the patient's progressive lung
damage.
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Subsequent pulmonary imaging over the following year showed a steady progression of his consolidations and traction bronchiectasis, significant decrease in ground-glass abnormalities throughout both lungs, a decrease in FDG uptake indicative of decrease in the inflammatory process and formation of scar tissue with a remarkable spatial shift to the mid and upper lung zones and progressive appearance of new cystic lesions in the upper lobes bilaterally (Figure 4).