CTICasesBronchial Anastomotic Stenosis and Global Air Trapping Post-Lung Transplant
Imaging findings
Baseline CT of the chest in a patient with a history of a solitary right lung transplant demonstrates a normal, patent bronchial anastomosis with no stenosis. A follow-up CT of the chest obtained two months later for spirometric decline reveals severe, circumferential narrowing of the right main bronchus anastomosis, with a reduction in luminal diameter of approximately 50%. Expiratory CT imaging shows global air trapping throughout the transplanted lung. High-definition bronchoscopy images confirm critical concentric stenosis of the anastomotic site, which was subsequently treated with an endobronchial stent.
Key takeaways
Bronchial anastomotic stenosis is a well-known airway complication occurring in up to 10% of lung transplant recipients, typically presenting within the first year post-transplant due to ischemia, infection, or excessive granulation tissue formation at the surgical anastomosis. While CT can easily demonstrate the focal narrowing, expiratory imaging is valuable to assess for associated functional air trapping. Treatment usually involves bronchoscopic balloon dilation and/or stent placement to restore airway patency.
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