Department of Radiology, Duke University Medical Center, Durham, NC, USA.
AJR Am J Roentgenol. 2011 Mar;196(3):W273-9. doi: 10.2214/AJR.10.4468.
The purpose of this article is to determine the clinical features, imaging findings, and possible causes of pneumatosis intestinalis (PI) or pneumoperitoneum that developed in bilateral lung transplant recipients.
From December 2004 to July 2009, seven (2%) of 321 bilateral lung transplant recipients (two women and five men; age range, 25-66 years) who developed PI or pneumoperitoneum, or both, were identified. Medical records were reviewed to determine the clinical presentation, laboratory findings, and medications at the time of presentation of PI or pneumoperitoneum. Hospital course and time to resolution of PI or pneumoperitoneum were recorded. Common factors that might explain the cause of the PI and pneumoperitoneum were evaluated. Two experienced abdominal radiologists reviewed all imaging studies and recorded the specific findings for each patient.
All patients had minimal or no symptoms, normal laboratory study results, and no systemic, intestinal, or proven respiratory infections. All patients but one were receiving triple immunosuppressive agents (i.e., prednisone, azathioprine, and tacrolimus). The imaging findings were similar in five of the patients with the PI dominated by a linear and cystic appearance and involving only the colon. Three of the six patients with PI had both PI and pneumoperitoneum. The mean time to resolution of PI was 24 days. No definite cause for the PI and pneumoperitoneum could be determined in the seven patients.
Bilateral lung transplant recipients may develop benign PI or pneumoperitoneum after surgery. Benign PI in bilateral lung transplant recipients has a similar and specific linear and cystic appearance and is not due to ischemic bowel. No specific cause for the PI and pneumoperitoneum could be determined.
本文旨在确定发生于双侧肺移植受者的肠气肿（PI）或气腹的临床特征、影像学表现和可能病因。
2004 年 12 月至 2009 年 7 月，我们发现 321 例双侧肺移植受者（2 例女性，5 例男性；年龄 25-66 岁）中有 7 例（2%）发生 PI 或气腹，或两者皆有。我们对这些患者的临床特征、实验室检查结果和发病时的用药情况进行了回顾性分析。记录了住院经过及 PI 或气腹的缓解时间。评估了可能导致 PI 和气腹的常见因素。两名经验丰富的腹部放射科医生对所有影像学资料进行了回顾，并记录了每位患者的具体表现。
所有患者均无明显症状，实验室检查结果正常，无全身性、肠道或明确的呼吸道感染。除 1 例患者外，其余患者均接受三联免疫抑制治疗（即泼尼松、硫唑嘌呤和他克莫司）。5 例 PI 患者的影像学表现相似，以线性和囊性表现为主，仅累及结肠。6 例 PI 患者中有 3 例同时存在 PI 和气腹。PI 缓解的平均时间为 24 天。7 例患者均无法明确 PI 和气腹的病因。
双侧肺移植受者术后可能会发生良性 PI 或气腹。双侧肺移植受者的良性 PI 具有相似的特定线性和囊性表现，并非由肠缺血所致。PI 和气腹的病因无法明确。
