CTICasesDonor-Derived Respiratory Bronchiolitis After Single Lung Transplant
Imaging findings
A patient with hypersensitivity-pneumonitis-related end-stage lung disease underwent single (right) lung transplant. Post-transplant CT of the transplanted right lung showed ill-defined, smudgy, centrilobular ground-glass nodules predominantly in the upper lobe, initially raising concern for respiratory bronchiolitis versus hypersensitivity pneumonitis recurrence; biopsy of the donor lung confirmed pathology-proven respiratory bronchiolitis, attributed to a smoking history in the donor.
Key takeaways
New centrilobular ground-glass nodules in a transplanted lung should prompt consideration of donor-derived respiratory bronchiolitis when the donor had a smoking history, and while pathologic confirmation of respiratory bronchiolitis is not always pursued because the finding is so common in smokers, having biopsy-proven pathology in this case helped resolve initial diagnostic uncertainty in the early post-transplant setting.
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