Graft-versus-host disease chest x ray

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Graft-versus-host disease

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]

Overview

A chest X-ray can be done to evaluate for pneumonitis, which can be a manifestation of pulmonary GvHD. A variety of radiographic features can be seen.

Chest X-Ray

A chest X-ray can be done to assess for immune attack in the lungs, such as pneumonitis. Pneumonitis is a less common GvHD manifestation compared to rash, liver dysfunction, and diarrhea. However, pneumonitis has been known to occur. Pneumonitis presents radiographically as a nodular or interstitial pattern. There can be inflammation in the peri-bronchiolar tissue, resulting in variable areas of hyperdensity and hypodensity on the chest X-ray. Ground glass appearance and consolidative opacities can also be seen.[1] CT scan of the chest can better diagnose pneumonitis.

A chest X-ray is also an important diagnostic tool in the evaluation of other stem cell transplant-related conditions, such as pneumonia, volume overload, transfusion-related acute lung injury (TRALI). Chest X-ray can help differentiate pulmonary GvHD from these conditions. Volume overload and transfusion-related acute lung injury (TRALI) will show blunting of the costophrenic angles and pulmonary vascular engorgement, reflecting excess fluid in the lungs.

References

  1. Nishino M, Boswell EN, Hatabu H, Ghobrial IM, Ramaiya NH (2015). "Drug-Related Pneumonitis During Mammalian Target of Rapamycin Inhibitor Therapy: Radiographic Pattern-Based Approach in Waldenström Macroglobulinemia as a Paradigm". Oncologist. 20 (9): 1077–83. doi:10.1634/theoncologist.2015-0033. PMC 4571812. PMID 26205737.



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