Table 3.

Salient Clinical Features of Lung Injury Syndromes not Defined Under IPS

Parenchyma

Radiation pneumonitis: restrictive findings on spirometry. Impaired DLCO, onset 2-4 months after therapy.

Pulmonary alveolar proteinosis: may occur early or late (1-2 years) after transplantation. Chest radiography may show crazy paving pattern. BAL shows milky periodic-acid-Schiff–positive milky fluid.

Vascular endothelium

Pulmonary veno-occlusive disease: occurs 2-6 months after transplantation and results in pulmonary hypertension. Histology reveals fibrous intimal proliferation of pulmonary venules.

Pulmonary cytolytic thrombi: observed in pediatric HSCT recipients 2-3 months after HSCT. Chest CT may show pulmonary nodules. Histology reveals thrombi in small to medium distal pulmonary vessels, associated with pulmonary infarction.

Transfusion-related acute lung injury: Present with fever, chills, leukopenia, acute dyspnea, and hypotension within 6 hours of cellular product infusion. Histology reveals aggregation of leukocytes in pulmonary vasculature.

Pulmonary artery hypertension: insidious onset of dyspnea, within 0-6 months after transplantation. Detected by follow-up echocardiogram. Histology reveals intimal hyperplasia in small pulmonary vessels.

Pulmonary thrombo-embolism: acute onset of fever, dry cough and dyspnea due to embolus in a pulmonary vein detected by chest CT or lung angiography.