CTICasesRecurrent Sarcoidosis in a Lung Transplant Recipient
Imaging findings
Pre-transplant imaging in a 58-year-old shows fibrotic sarcoidosis with bullae and architectural distortion. After bilateral lung transplantation there is pleural thickening with a chronic effusion and rounded atelectasis, producing a trapped lung. A subsequent study shows a new nodule together with clustered nodular areas in the right lower lobe and a few additional nodules and small clusters elsewhere. Transbronchial biopsy and lavage grew no organism; histology showed clusters of non-caseating granulomas identical to sarcoidosis, without other findings.
Key takeaways
Sarcoidosis can recur in a transplanted lung, and although new nodules in a transplant recipient almost always prompt a search for infection, recurrence is a genuine alternative — here proven as classic epithelioid non-caseating granulomas with no granulomatous infection. Lymphangioleiomyomatosis is the other well-recognised recurring disease, being considered neoplastic; Langerhans cell histiocytosis is theoretically possible but unlikely since these patients are usually no longer smoking by transplantation. Recurrence may be under-observed because these patients are already immunosuppressed against rejection. Chronic pleural effusion with trapped lung is a common post-transplant problem, attributed to division of the lymphatics rather than to anastomotic complications, which have become less frequent with better size matching and technique.
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