Presentation
Persistent shortness of breath after recent allogenic hematopoietic stem cell transplantation.
Patient Data
Central, peribronchovascular opacities, with upper and mid zone predominance. No cavitation.
No pleural effusion.
Heart is borderline enlarged.
Right central venous catheter with the tip in the superior vena cava.
Widespread patchy interstitial and ground-glass opacities with upper zone predominance.
No nodules, masses or cavitation. No tree-in-bud opacity or honeycombing.
No bronchiectasis or bronchiolectasis.
No thoracic lymphadenopathy.
In the context of recent stem cell transplantation, the CT findings suggest acute pulmonary graft versus host disease (GVHD).
Dilated centrally located small bowel. Prominent air-filled transverse colon, within normal limits, (<6cm). No pneumoperitoneum.
Diffuse circumferential bowel wall thickening involving the right colon, (cecum, ascending colon and hepatic flexure). Thickening of the ileocecal valve and terminal ileum. Mildly dilated gas-filled ileal loops.
Multiple sites of pneumatosis intestinalis.
No pneumoperitoneum or portal venous gas.
Moderate ascites.
Annotated images showed the right-sided colonic wall thickening. In the clinical context of neutropenia (most commonly seen in patients with leukemia or post-transplantation), these CT features are highly suggestive of neutropenic colitis/typhlitis.
Case Discussion
The patient had stem cell transplantation two months earlier for acute myeloid leukemia and developed persistent shortness of breath followed by signs of intestinal obstruction, in keeping with pulmonary graft-versus-host disease (GVHD) and typhlitis.
Graft versus host disease is a frequent complication of allogeneic hematopoietic stem cell transplantation, also known as bone marrow transplantation.
It is one of the major complications of this treatment and can present either early, (within the first 100 days) or later, (more than 100 days) following post-allogeneic hematopoietic stem cell transplantation.
Chronic pulmonary GVHD can present as organizing pneumonia or pulmonary fibrosis.
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