Melloni G, Zannini P, Solca M, Baisi A, Nastri G, Vanzulli A, Del Maschio A
Istituto Malattie dell'Apparato Cardiovascolare e Respiratorio, Università degli Studi di Milano.
Radiol Med. 1995 May;89(5):623-7.
March, 1991, to June, 1992, five lung transplantations for end-stage lung disease were successfully performed at the Ospedale Maggiore Policlinico in Milan. All patients underwent high-resolution CT (HRCT) of the lung in a complex follow-up program to identify specific abnormalities of acute and chronic rejection (bronchiolitis obliterans) and to monitor the resolution of the bronchial anastomosis. Twenty-two HRCT exams were performed. In patients with acute rejection HRCT failed to identify specific abnormalities of lung parenchyma. In contrast, in one patient with pathological evidence of early bronchiolitis obliterans HRCT showed decreased peripheral vascularization. In the study of the bronchial anastomosis, HRCT showed optimal anastomosis resolution in 4 patients, whereas in one patient with a granuloma demonstrated by fibrobronchoscopy it confirmed the lesion showing also a small pneumomediastinum. Even though the HRCT finding of decreased peripheral vascularization does not appear to be specific for bronchiolitis obliterans, it may be of value in suggesting the diagnosis of early bronchiolitis obliterans in lung transplant. HRCT should be used in all patients with bronchoscopic diagnosis of bronchial complication to study the lesion and its mediastinal spread.
1991年3月至1992年6月，米兰的马焦雷综合医院成功地为5例终末期肺病患者实施了肺移植手术。在一项综合随访计划中，所有患者均接受了肺部高分辨率CT（HRCT）检查，以识别急性和慢性排斥反应（闭塞性细支气管炎）的特定异常情况，并监测支气管吻合口的愈合情况。共进行了22次HRCT检查。在急性排斥反应患者中，HRCT未能识别出肺实质的特定异常情况。相比之下，在1例有早期闭塞性细支气管炎病理证据的患者中，HRCT显示外周血管化减少。在支气管吻合口的研究中，HRCT显示4例患者的吻合口愈合情况良好，而在1例经纤维支气管镜检查发现肉芽肿的患者中，HRCT证实了该病变，同时还显示有小范围的纵隔气肿。尽管外周血管化减少的HRCT表现似乎并非闭塞性细支气管炎所特有，但它可能有助于提示肺移植中早期闭塞性细支气管炎的诊断。对于所有经支气管镜诊断为支气管并发症患者，均应使用HRCT来研究病变及其纵隔扩散情况。
