Pulmonary Infections After Bone Marrow Transplantation

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Pulmonary Infections After Bone Marrow Transplantation: High-

Resolution CT Findings in 111 Patients

http://www.ajronline.org/cgi/content/abstract/185/3/608

Dante L. Escuissato1, Emerson L. Gasparetto1, Edson Marchiori2,

a de Melo Rocha1, César Inoue1, Pasquini3 and Nestor

L. Müller4

1 Department of Diagnostic Radiology, the University of Parana,

Curitiba, Brazil.

2 Department of Diagnostic Radiology, the University of Rio de

Janeiro, Rio de Janeiro, Brazil.

3 Bone Marrow Transplantation Unit, the University of Parana,

Curitiba, Brazil.

4 Department of Radiology, Vancouver General Hospital, 899 W 12th

Ave., Vancouver, BC V5Z 1M9, Canada.

OBJECTIVE. The purpose of this study was to review the high-

resolution CT findings in patients with pulmonary infection after

bone marrow transplantation and to determine distinguishing features

among the various types of infection.

MATERIALS AND METHODS. This study included 111 consecutive bone

marrow transplant recipients who had documented pulmonary infection,

high-resolution CT of the chest performed within 24 hr of the

beginning of symptoms, and proven diagnosis within 1 week of the

onset of symptoms. Two radiologists analyzed the CT scans and

reached final decisions regarding the findings by consensus.

Statistical analysis was performed using the Fisher's exact test and

multivariate analysis; a p value of less than 0.05 was considered

statistically significant.

RESULTS. The pulmonary infections were due to viruses (n = 57),

bacteria (n = 26), fungi (n = 21), and protozoa (n = 1). Six

patients had more than one organism responsible for the infection.

Nodules that were 1 cm or more in diameter were seen in 13 (62%) of

21 patients with fungal pneumonia, five (19%) of 26 patients with

bacterial pneumonia (p = 0.0059), three (10%) of 30 with respiratory

syncytial virus (RSV) pneumonia (p = 0.0001), and three (14%) of 22

with cytomegalovirus pneumonia (p = 0.0016). The halo sign was

present in 10 of 21 patients with fungal pneumonia, two of 26 with

bacterial pneumonia (p = 0.0026), three of 30 with RSV pneumonia (p

= 0.0036), and one of 22 with cytomegalovirus pneumonia (p =

0.0015). There was no statistically significant difference in the

prevalence of the other CT patterns including small nodules, ground-

glass attenuation, and air-space consolidation among viral,

bacterial, and fungal infections (all p > 0.05).

CONCLUSION. The presence of large nodules and visualization of the

halo sign are most suggestive of fungal infection. Other high-

resolution CT patterns are not helpful in distinguishing among the

various types of infection seen in bone marrow transplant

recipients.