CTICasesConstrictive Bronchiolitis after Stem Cell Transplant
Imaging findings
A patient with myeloma treated with a stem cell transplant in 2019 has, compared with a prior study, big and black lungs with lower-lung-zone mosaic attenuation dominated by low-attenuation areas, slightly thicker and more dilated bronchial walls, and a striking finding on the expiratory series: despite the expiratory acquisition, airways remain open and the posterior tracheal membrane is not bowed forward, indicating trapped air that cannot be expelled in the time allowed. PFTs progressed from mild obstruction in 2017 to very severe obstruction by 2020.
Key takeaways
Constrictive bronchiolitis (bronchiolitis obliterans) from graft-versus-host disease after stem cell transplant produces diffuse severe air trapping with mosaic attenuation and predominantly black lungs, a finding easily overlooked because the lungs look clear. Expiratory imaging that fails to show the normal increase in attenuation (open airways, non-bowed posterior membrane) reflects true air trapping rather than a poor expiratory effort; small airway nodules precede air trapping, and established bronchiolar disease with severe obstruction is a late finding correlating with a steep PFT decline.
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See all cases from October 17, 2020 →