High-resolution computed tomography of chest complications in patients treated with hematopoietic stem cell transplantation

Abstract

Hematopoietic stem cell transplantation (HSCT) has become a standard method for treating patients with hematological malignancies. Preconditioning chemotherapeutic drugs, total body irradiation (TBI), or chronic graft-versus-host disease (GVHD) can cause several chest complications after HSCT. Because immunosuppression is marked after HSCT, it takes at least 1 year for the immune system to recover completely. Therefore, several infectious and noninfectious complications may occur within the year after HSCT. HSCT-specific complications occur in a characteristic temporal sequence associated with the period following HSCT. During the neutropenic phase, bacterial pneumonia, fungal infection, pulmonary edema, and diffuse alveolar hemorrhage may occur. During the early phase, pneumocystis pneumonia, cytomegalovirus pneumonia, engraftment syndrome, and idiopathic pneumonia syndrome are the common complications. During the late phase, constrictive bronchiolitis and organizing pneumonia may occur probably associated with chronic GVHD. Although high-resolution CT findings lack specificity, the frequency and likelihood of occurrence of certain complications in certain phases and sometimes characteristic features (such as a CT halo sign for fungal infection) facilitate early detection of a life-threatening complication.