CTICasesBronchiolitis Obliterans and Tracheomalacia Post-Lung Transplantation
Imaging findings
Expiratory chest CT shows a diffuse, highly geographic mosaic attenuation pattern with extensive air trapping in a patient who underwent double lung transplantation several years prior. High-resolution CT of the trachea demonstrates a lunate or lemon-shaped configuration on inspiration, with severe expiratory collapse of the posterior membrane (the "frown sign"), consistent with concomitant tracheomalacia.
Key takeaways
Constrictive bronchiolitis, or bronchiolitis obliterans syndrome (BOS), is the classic manifestation of chronic lung transplant rejection, radiographically presenting as geographic air trapping and mosaic perfusion on expiratory CT. Tracheomalacia and bronchomalacia can also develop post-transplant, characterized by excessive expiratory airway collapse.
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