Under Pressure: Post-Transplant Lymphoproliferative Disease: A Case of Pulmonary Artery External Compression

Abstract

Post-transplant lymphoproliferative disorder (PTLD) is an often fatal complication of cardiac transplantation that occurs in 2% to 6% of transplant recipients. We report a case in which PTLD led to pulmonary artery external compression and multimodality imaging showed key features in the diagnosis, management, and follow-up. (Level of Difficulty: Intermediate.).

Keywords: CT, computed tomography; EBV, Epstein-Barr virus; Ig, immunoglobulin; PTLD, post-transplant lymphoproliferative disorder; TAPSE, tricuspid annular plane systolic excursion; TTE, 2-dimensional transthoracic echocardiogram; biopsy; computed tomography; echocardiography; external compression; post-transplant lymphoproliferative disease; pulmonary artery.

Graphical abstract

Figure 1

Multimodality Imaging of PLTD Leading to Pulmonary Artery External Compression (A) A 2-dimensional transthoracic echocardiogram, parasternal short-axis modified view, showing an echogenic structure causing obstruction (asterisk) at the level of the pulmonary bifurcation. (B) Color Doppler imaging displaying flow acceleration. (C) A 2-dimensional transthoracic echocardiogram, parasternal short-axis view, showing a dilated right ventricle with a flattened interventricular septum. (D) Computed tomography revealing multiple large, necrotic masses, the largest measuring 6.2 cm and causing partial effacement and narrowing (asterisk) of the right and left pulmonary arteries. (E) Histologic features. (F) Post-treatment computed tomography. PLTD = post-transplant lymphoproliferative disorder.