A 32-year-old male underwent a lung transplant 1 year ago. Initially, he had an episode of acute rejection requiring increased immunosuppression. He now presents with symptoms of low-grade fever and generalized fatigue, fever, and weight loss. Chest x-rays are obtained.The most likely diagnosis of this patient is
Correct Answer: Posttransplant lymphomatoid disorder (PTLD)
Description: The PA view shows a rounded opacity in the right lower zone. The horizontal fissure is seen distinctly through and separate from this opacity, suggesting that this is not a pseudotumor, i.e., fluid in the fissure. A double density shadow is seen in the subcarinal area. A band of linear atelectasis is seen in the right lower zone. The patient has posttransplantation lymphoproliferative disorder (PTLD) confirmed by a needle biopsy. The incidence of PTLD in lung transplant recipients is approximately 2% to 5% and is higher than in other solid organ transplants. It is closely associated with Epstein-Barr virus infection, and children are more prone to develop this disorder. The majority of PTLDs are non-Hodgkin's lymphomas and B-cell tumors. Typical radiographic features include multiple nodules, mediastinal adenopathy, airspace disease, and pleural effusions. Aspergilloma or mycetoma is a fungus ball that occurs in cystic or cavitary disease and is unrelated to lung transplant. Pseudotumor or fluid in the horizontal or oblique fissure occurs in cases of congestive hea failure and is seen radiographically within the confines of these fissures.
Category:
Radiology
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