CTICasesRestrictive Allograft Syndrome (Post-Transplant Upper Lobe Progressive Fibrosis)
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Imaging findings
A patient who underwent a double lung transplant in 2007 initially showed signs of bronchiolitis obliterans from chronic rejection in 2014, with upper lobe predominant traction bronchiectasis, ground glass opacity, consolidation, and mosaic attenuation. A recent CT shows severe progression, with almost complete consolidation and severe varicoid traction bronchiectasis in the upper lobes, significant upper lobe volume loss, and increased mosaic attenuation and patchy ground-glass opacity in the lower lobes.
Key takeaways
Restrictive allograft syndrome is a severe manifestation of chronic rejection in lung transplant recipients, characterized by progressive upper lobe fibrosis and volume loss, often combined with obstructive physiology from bronchiolitis obliterans. This leads to graft failure with restrictive physiology, and morphologically mimics pleuropulmonary fibroelastosis. The precise etiology for the upper lobe predominance in this chronic rejection scenario is not fully understood.
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