Bin Saeedan Mnahi, Rizk Alain, Yadav Ruchi, Ghosh Subha
From the Section of Thoracic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH.
J Comput Assist Tomogr. 2020 May/Jun;44(3):314-327. doi: 10.1097/RCT.0000000000000996.
Airway complications (ACs) after lung transplant remain a challenge and include bronchial dehiscence, bronchial stenosis, tracheobronchomalacia, infections, and bronchial fistulas. The spectrum of complications may coexist along a continuum and can be classified as early (<1 month after transplant) or late (>1 month), and anastomotic or nonanastomotic. Bronchiolitis obliterans is the most common form of chronic lung allograft rejection. Airway compromise is seen in rare instances of lung torsion, and imaging may provide helpful diagnostic clues. Computed tomography (CT) and bronchoscopy play major roles in the diagnosis and treatment of ACs after lung transplant. Chest CT with advanced postprocessing techniques is a valuable tool in evaluating for airways complications, for initial bronchoscopic treatment planning and subsequent posttreatment assessment. Various bronchoscopic treatment options may be explored to maintain airway patency. The goal of this article is to review imaging findings of ACs after lung transplantation, with emphasis on chest CT and bronchoscopic correlation.
肺移植后的气道并发症（ACs）仍然是一个挑战，包括支气管裂开、支气管狭窄、气管支气管软化、感染和支气管瘘。并发症谱可能在一个连续过程中共存，可分为早期（移植后<1个月）或晚期（>1个月），以及吻合口或非吻合口并发症。闭塞性细支气管炎是慢性肺移植排斥反应最常见的形式。在罕见的肺扭转病例中可见气道受压，影像学检查可能提供有用的诊断线索。计算机断层扫描（CT）和支气管镜检查在肺移植后气道并发症的诊断和治疗中起主要作用。采用先进后处理技术的胸部CT是评估气道并发症、进行初始支气管镜治疗规划和后续治疗后评估的宝贵工具。可探索各种支气管镜治疗方案以维持气道通畅。本文的目的是回顾肺移植后气道并发症的影像学表现，重点是胸部CT与支气管镜检查的相关性。
