CTICasesMetapneumovirus Bronchopneumonia in Multiple Myeloma Patient Post-Transplant
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Imaging findings
Initial CT shows a posterior mediastinal mass expanding over multiple vertebral segments with subtle enhancement extending into the neural foramen, initially deemed a plasmacytoma. Follow-up CT shows growth. Later, after stem cell transplant, a radiograph shows radiation fibrosis. A subsequent CT shows new consolidation in the right upper lobe, smooth septal thickening, varied nodules (centrilobular, tree-in-bud, larger ground-glass, and discrete nodules occupying secondary pulmonary lobules), and consolidation, consistent with a viral bronchopneumonia.
Key takeaways
Plasmacytomas can present as posterior mediastinal masses and are often part of multiple myeloma. Post-transplant, immunocompromised patients are susceptible to various infections. Metapneumovirus can cause a bronchiolitis/bronchopneumonia with diverse imaging features including centrilobular nodules, tree-in-bud, ground-glass opacities, and consolidation, often mimicking fungal infection but responding to supportive care. Radiation fibrosis is an expected sequela of radiation therapy.
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