CTICasesPost-Transplant Lymphoproliferative Disorder (PTLD)
Imaging findings
Chest radiograph obtained several months after a bilateral lung transplant reveals new nodular opacities in the lung bases, mild consolidation, and pleural effusions. Chest CT confirms the presence of numerous well-defined, solid pulmonary nodules that are predominantly distributed in the lower lobes. Pathopathologic analysis of a nodule biopsy confirms post-transplant lymphoproliferative disorder (PTLD) with Epstein-Barr virus (EBV) positivity.
Key takeaways
Post-transplant lymphoproliferative disorder is a serious complication of solid organ transplantation related to therapeutic immunosuppression, often driven by EBV reactivation. While multiple basal pulmonary nodules in a lung transplant recipient typically raise concern for opportunistic infections such as invasive aspergillosis, cryptococcosis, or Nocardia, PTLD must remain high on the differential diagnosis. Biopsy is essential to differentiate neoplastic lymphoproliferation from infection, as treatment strategies differ significantly and require reduction of immunosuppression or targeted chemotherapy.
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