Holland S A, Hutton L C, McKenzie F N
Department of Diagnostic Radiology, University of Western Ontario, London.
Can Assoc Radiol J. 1989 Apr;40(2):94-7.
The chest radiographic findings and pulmonary radionuclide studies of four patients who underwent heart-lung transplantation between May 1983 and June 1986 were reviewed retrospectively. The two long-term survivors both developed bronchiolitis obliterans (presenting at 32 months postoperatively in the first patient and 14.5 months postoperatively in the second). The etiology of this is likely to be multifactorial and includes pulmonary rejection which may develop without concomitant cardiac rejection. The radiologist must be alert to this complication in heart-lung transplantation. The chest radiographs in our two patients showed diminution of peripheral bronchovascular markings and overinflation. The importance of careful screening of the radiographs of potential donors to detect pneumonia is emphasized. In one patient, a unilateral pneumothorax spread contralaterally due to the absence of normal anatomic barriers. The "reimplantation response" was not a prominent feature and was seen in one patient only. This response has been observed in heart-lung transplant recipients during the second postoperative week. The radiologic appearance is that of interstitial edema not explained by any clinical or hemodynamic findings.
回顾性分析了1983年5月至1986年6月期间接受心肺移植的4例患者的胸部X线表现和肺放射性核素检查结果。2例长期存活者均发生了闭塞性细支气管炎（第1例患者于术后32个月出现，第2例于术后14.5个月出现）。其病因可能是多因素的，包括可能在无心脏排斥反应的情况下发生的肺排斥反应。放射科医生必须警惕心肺移植中的这种并发症。我们这2例患者的胸部X线片显示外周支气管血管纹理减少和过度充气。强调了仔细筛查潜在供体的X线片以检测肺炎的重要性。1例患者由于缺乏正常的解剖屏障，单侧气胸向对侧蔓延。“再植反应”不是一个突出特征，仅在1例患者中出现。这种反应在心肺移植受者术后第二周观察到。放射学表现为间质性水肿，无任何临床或血流动力学表现可解释。
