CTICasesMosaic Attenuation from Chronic Lung Transplant Rejection
Imaging findings
Chest CT in a single-lung transplant recipient demonstrates a classic, highly lobular, geographic mosaic pattern of attenuation in the allograft, with expiratory air trapping confirmed on expiratory imaging. The patient's native lung exhibits severe, diffuse cystic end-stage fibrotic changes (honeycombing) from idiopathic pulmonary fibrosis (IPF).
Key takeaways
A mosaic pattern of attenuation represents regional differences in lung perfusion and ventilation, which on expiratory CT is confirmed to be due to air trapping from small airways disease. In a lung transplant recipient, this pattern typically reflects bronchiolitis obliterans syndrome (BOS), a manifestation of chronic allograft rejection.
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