Table 2.
Abnormal parenchymal findings in hematologic malignancies and hematopoietic cell transplantation patients warranting consideration of lung sampling for diagnosis
| Radiographic Abnormalitiesa | Onset | Distribution/Sign |
|---|---|---|
| Airspace consolidation | Acute: Infection (bacteria) Subacute/chronic: Infection (fungi, Nocardia or Actinomyces spp, mycobacteria), drug toxicity, COP/BOOP, malignancy |
Focal: Infection (bacteria), malignancy Multi-focal/diffuse: Infection (bacteria, fungi/mold), COP/BOOP, drug toxicity, malignancy Air-bronchogram: Infection (bacteria) |
| Ground-glass attenuation | Acute: Infection (early PJP, CMV, HHV-6, CARV, atypical bacteria), alveolar hemorrhage, IPS,b acute radiation pneumonitis, eosinophilic pneumonia, pulmonary edema, ARDS, TRALI Subacute/chronic: Infection (CMV, atypicals), drug/radiation toxicity, malignancy, PAP, PVODb |
Multi-focal/diffuse: Infection (PJP, CMV, CARV, HHV-6), drug/radiation toxicity, DAH, IPS,b PERDS,b COP/BOOP, ARDS, TRALI Mosaic attenuation & air trapping: BOSb/chronic GVHD |
| Nodules & mass lesions | Acute: Infection (necrotizing bacteria, eg, Pseudomonas, Staphylococcus aureus, Klebsiella spp; Aspergillus spp) Subacute/chronic: Infection (fungi, Nocardia, mycobacteria), malignancy |
Halo-sign: Aspergillus infection Reversed Halo-sign: COP Tree-in-bud: Infection (atypical bacteria, mycobacteria, fungi), mucoid impaction Diffuse centrilobular nodules: viral bronchiolitis, late BOSb |
| Interstitial infiltrates | Acute: Infection (late PJP, viruses, atypical bacteria), pulmonary edema, ARDS, TRALI Subacute/chronic: Infection (mycobacteria), drug/radiation toxicity, malignancy (leukemic infiltration), PAP, PVODb |
Multi-focal/diffuse: Infection (PJP, viruses,atypical bacteria), pulmonary edema, ARDS, TRALI, malignancy (leukemic infiltration), PAP Crazy-paving: PAP, pulmonary edema, DAH |
Abbreviations: ARDS, acute respiratory distress syndrome; BOOP, bronchiolitis obliterans organizing pneumonia; BOS, bronchiolitis obliterans syndrome; CARV, community-acquired respiratory virus; CMV, cytomegalovirus; COP, cryptogenic organizing pneumonia; DAH, diffuse alveolar hemorrhage; GVHD, graft-versus-host disease; HHV-6, human herpes virus 6; IPS, idiopathic pneumonia syndrome; PAP, pulmonary alveolar proteinosis; PERDS, periengraftment respiratory distress syndrome; PJP, Pneumocystis jirovecii pneumonia; PVOD, pulmonary veno-occlusive disease; TRALI, transfusion-related acute lung injury.
In some cases, findings may be apparent on chest radiography, but chest computed tomography scans, especially when performed at high resolution, allow for earlier detection. Common radiologic patterns include airspace consolidation, ground-glass attenuation, interstitial infiltrates, and nodular/mass lesions.
Unique to hematopoietic cell transplant recipients.