Rejection and Graft vs Host Disease

Radiology

Figure 1

Transplant Rejection

This image of a patient with bilateral lung transplants shows enlargement with patchy hyperlucency and attenuation of peripheral vascular markings on the right side. Similar foci of air trapping were seen bilaterally at other levels.

Similar changes may occur in graft vs host disease in bone marrow transplant patients.


Pathology

Figure 2. Subepithelial inflammation and fibrosis characterize bronchiolitis obliterans in both lung rejection and graft vs host disease.

bronchiole

 

Bronciolitis Obliterans in a Bone Marrow Transplant Patient

Outline the bronchiole.

Note that the smooth muscle layer has been destroyed on the right side of the airway. Epithelium is focally eroded. Mucus plugs the lumen.

 

Figure 3. Lung transplant patient: Subepithelial fibrosis is prominent in this bronchiole. Smooth muscle has been destroyed on the right side of the airway. Epithelium is partially eroded. Note the artery with subtle medial and adventitial thickening at the bottom of the image and the scattered hemosiderin-filled macrophages indicating old bleeding (a common finding in these biopsies).

bronchiole1

Figure 3

Outline the bronchiole.

 

 

Lung transplant patient: The obliterative process may involve bronchi also. Here dense collagenous scar infiltrated with lymphocytes occludes a bronchial lumen. The smooth muscle layer has been destroyed.

bronchuscartilagecartilage

Figure 4

Outline the occluded bronchus.

Find the bronchial cartilage.

References

Estenne M, Hertz M. Bronchiolitis obliterans after human lung transplantation. Am J Respir Crit Care Med 2002; 166:440-444.

Nathan S, Ross D, Belman M, Shain S, Elashoff J, Kass R, Koerner S. Bronchiolitis obliterans in single-lung transplant recipients. Chest. 1995; 107:967-972. Abstract

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