Masaaki Sato, MD, PhD, David M. Hwang, MD, PhD, Thomas K

Slides:

Advertisements

Similar presentations

These are actual cases to: –Stimulate your reading –Test your knowledge of the material Look for the sound icon (usually in the upper right hand corner.

Advertisements

Clinical History Locke : 55 yo male past medical history of hypothyroidism presents with increasing dyspnea. Patient was treated with several.

NYU Medical Grand Rounds Clinical Vignette Lucy Doyle MD, PGY-2 March 24, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.

Sixth INTERMACS annual report: A 10,000-patient database James K. Kirklin, MD, David C. Naftel, PhD, Francis D. Pagani, MD, PhD, Robert L. Kormos, MD,

Figure 1. Proposed mechanisms in the pathogenesis of hypersensitivity pneumonitis. exaggerated immune reaction activation of the fibroblast accumulation.

History : 38-year-old male with progredient dyspnea, productive cough, frequent airway infections and restrictive ventilatory defect. BAL and Biopsy were.

Janet T. Lee, MD, Rosemary F. Kelly, MD, Marshall I

Predictors of survival in restrictive chronic lung allograft dysfunction after lung transplantation Stijn E. Verleden, PhD, David Ruttens, MD, Elly Vandermeulen,

Polymyositis Associated With Severe Interstitial Lung Disease

A 35-Year-Old Man With Fever, Dyspnea, and Diffuse Reticular Opacities

Case Report: Diffuse Interstitial Pulmonary Fibrosis (Hamman-Rich Syndrome): Diagnosis by Lung Biopsy; Treated with Cortico-Steroids ELLIS J. VAN SLYCK,

Management of Myositis-Related Interstitial Lung Disease

Jeffrey Bradley, MD Journal of Thoracic Oncology

Ground-Glass Centrilobular Nodules on Multidetector CT Scan

Low vitamin D levels are associated with increased rejection and infections after lung transplantation Erin M. Lowery, MD, Bradford Bemiss, MD, Thomas.

Volume 117, Issue 1, Pages (January 2000)

Volume 101, Issue 8, Pages (August 2007)

Volume 139, Issue 1, Pages (January 2011)

Clinical disease due to enterovirus D68 in adult hematologic malignancy patients and hematopoietic cell transplant recipients by Alpana Waghmare, Steven.

A 48-Year-Old Woman With Headache and Respiratory Failure

Osimertinib-Induced Interstitial Lung Disease Presenting as Eosinophilic Pneumonia Hiroaki Tachi, MD, Toshihiro Shiozawa, MD, Chio Sakai, MD, Mariko Kasuga,

Acceleration of pulmonary interstitial fibrosis in a patient with myeloperoxidase- antineutrophil cytoplasmic antibody-positive erythema elevatum diutinum

Successful Osimertinib Rechallenge in a Patient with T790M-Mutant Non–Small Cell Lung Cancer after Osimertinib-Induced Interstitial Lung Disease Eisaku.

Diagnostic Approach to the Patient With Diffuse Lung Disease

Idiopathic Pulmonary Fibrosis: Current Concepts

Effect of volume reduction on lung transplant timing and selection for chronic obstructive pulmonary disease Joseph E. Bavaria, MD, Alberto Pochettino,

Diagnosis and treatment of thoracic aortic intramural hematoma

Volume 150, Issue 1, Pages e5-e8 (July 2016)

Upper Lobe Pulmonary Fibrosis Associated With High-Dose Chemotherapy Containing BCNU for Bone Marrow Transplantation James M. Parish, MD, John R. Muhm,

Volume 152, Issue 2, Pages e21-e24 (August 2017)

Volume 145, Issue 3, Pages (March 2014)

A 61-Year-Old Caribbean Man With Thrush and Acute Respiratory Failure

Trudie E. Muir, MD, Henry D. Tazelaar, MD, Thomas V

Characterization of Pneumonitis in Patients with Advanced Non-small Cell Lung Cancer Treated with Everolimus (RAD001) Dorothy A. White, MD, Lawrence.

Gabriela Gayer, Ifat Sarouk, Nayrouz Kanaany, Ori Efrati

M. Watanabe, MD, K. Natsuga, MD, PhD, M. Ota, MD, PhD, K. Ito, MD, PhD

Acute Exacerbation of Usual Interstitial Pneumonia After Resection of Lung Cancer Hiroaki Sugiura, MD, Atsuya Takeda, MD, PhD, Toshiko Hoshi, MD, PhD,

Christopher T. Salerno, MD, Soon J. Park, MD, Nathan S

Rheumatoid Arthritis-Associated Interstitial Lung Disease

Chok Limsuwat, MD, Philip J. Daroca, MD, Joseph A. Lasky, MD CHEST

Successful Crizotinib Retreatment after Crizotinib-Induced Interstitial Lung Disease Satoru Yanagisawa, MD, PhD, Akira Inoue, MD, PhD, Akira Koarai, MD,

Recurrent Fevers, Cough, and Pulmonary Opacities in a Middle-Aged Man

Radiological Changes After Stereotactic Radiotherapy for Stage I Lung Cancer Max Dahele, MBChB, MSc, David Palma, MD, Frank Lagerwaard, MD, PhD, Ben Slotman,

Successful Treatment with Erlotinib after Gefitinib-Induced Severe Interstitial Lung Disease Masayuki Takeda, MD, PhD, Isamu Okamoto, MD, PhD, Chihiro.

Chronic Cough and Bilateral Pneumothoraces in a Nonsmoker

Nonspecific interstitial pneumonia in a woman a, c) at the time of Sjögren's syndrome diagnosis and b) after 3 years. a, b) High-resolution computed tomography.

Treatment of primary infected aortic aneurysm without aortic resection

Diagnosis of Interstitial Lung Diseases

Rubinowitz Ami N. , MD, Moon Marianne , MD, Homer Robert , MD, PhD

Experience from an American Association for Thoracic Surgery Foundation for Thoracic Surgery Training Fellowship: Lung transplantation in Toronto General.

Alina A. Ionescu, Lisette S. Nixon, Dennis J. Shale

Third-time lung transplantation in a patient with cystic fibrosis

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Differentiating N0 Versus N1 Lung Cancer Kazuhiro Yasufuku, MD, PhD, Takahiro Nakajima,

Successful treatment of cepacia syndrome with a combination of intravenous cyclosporin, antibiotics and oral corticosteroids Francis J. Gilchrist, A.

Jeffrey Bradley, MD Journal of Thoracic Oncology

An 80-Year-Old Man With Hemoptysis and Unilateral Patchy Opacities

Pulmonary Hypertension in Patients With Interstitial Lung Diseases

Volume 155, Issue 3, Pages e69-e74 (March 2019)

L. Uppaluri, S.J. England, T.F. Scanlin Journal of Cystic Fibrosis

Volume 134, Issue 1, Pages (July 2008)

Bronchioloalveolar Carcinoma Presenting as Chronic Progressive Pulmonary Infiltrates in a Woman with HIV: A Diagnosis Worth Making Todd M. Erickson,

Ground-Glass Centrilobular Nodules on Multidetector CT Scan

Quiz page answers October 2004

Luke A. Seaburg, MD, Hiroshi Sekiguchi, MD CHEST

Interstitial lung abnormality in stage IV non-small cell lung cancer: A validation study for the association with poor clinical outcome Tetsuro Araki,

Volume 155, Issue 4, Pages e91-e96 (April 2019)

Acute Exacerbation of Interstitial Fibrosis After Pulmonary Resection

Ann Vu, MD, Robert Vassallo, MD, Jay H. Ryu, MD CHEST

A 40-Year-Old Man With Albinism and Progressive Dyspnea

Presentation transcript:

Progression pattern of restrictive allograft syndrome after lung transplantation Masaaki Sato, MD, PhD, David M. Hwang, MD, PhD, Thomas K. Waddell, MD, MSc, Lianne G. Singer, MD, Shaf Keshavjee, MD, MSc The Journal of Heart and Lung Transplantation Volume 32, Issue 1, Pages 23-30 (January 2013) DOI: 10.1016/j.healun.2012.09.026 Copyright © 2013 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 1 Acute exacerbation and definition of clinical course during the period of study. The first change in the slope of FEV1 after the initiation of acute exacerbation was taken as the end of the acute exacerbation episode. Clinical courses after an episode of acute exacerbation were classified based on post-exacerbation FEV1 changes. The Journal of Heart and Lung Transplantation 2013 32, 23-30DOI: (10.1016/j.healun.2012.09.026) Copyright © 2013 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 2 Changes in CT scan findings at the time of acute exacerbation. CT scans at the time of acute exacerbation were available and compared with those before acute exacerbation in 43 episodes of 23 patients. Acute exacerbation typically showed GGO, more often diffuse than patchy. Appearance or aggravation of consolidation was also a relatively common finding, whereas appearance or aggravation of interstitial reticular shadow or traction bronchiectasis was observed less frequently at the time of acute exacerbation. The Journal of Heart and Lung Transplantation 2013 32, 23-30DOI: (10.1016/j.healun.2012.09.026) Copyright © 2013 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 3 Changes in CT scan findings during intervals between acute exacerbations. During 25 acute exacerbation intervals in 18 patients, GGO usually showed improvement on CT scan, whereas other characteristics (interstitial reticular shadow, consolidation and traction bronchiectasis) tended to worsen. Not applicable (n/a) indicates that the type of abnormality did not exist before the interval and did not appear during the interval. The Journal of Heart and Lung Transplantation 2013 32, 23-30DOI: (10.1016/j.healun.2012.09.026) Copyright © 2013 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 4 A representative case of RAS after lung transplantation: Case 1. (A) Post-transplant PFT changes of a 62-year-old man who received cadaveric bilateral lung transplantation for COPD. (B)–(G) Chest CT scan of the same patient. (B) Post-transplant day 179, when the patient was stable. (C) Post-transplant day 361, when the patient was stabilized to some extent but still undergoing continuous functional deterioration. (D) Post-transplant day 760, when the patient was recovering from the second exacerbation. (E) Post-transplant day 284, when the patient underwent the first episode of acute exacerbation. DAD was detected in a transbronchial biopsy. Steroid pulse with empirical antibiotics treatment was conducted. Cyclosporine was switched to tacrolimus. (F) Post-transplant day 468, when the patient had the second episode of acute exacerbation. Once again, DAD was detected in a transbronchial biopsy. Azithromycin was initiated. (G) Post-transplant day 889, when the patient had the third episode of acute exacerbation. Arrows: time-point at which the CT scan was taken; white arrows: acute exacerbation. CsA, cyclosporine; FK, FK 506 (tacrolimus). The Journal of Heart and Lung Transplantation 2013 32, 23-30DOI: (10.1016/j.healun.2012.09.026) Copyright © 2013 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 5 A representative case of RAS after lung transplantation: Case 2. (A) Post-transplant PFT changes in a 28-year-old man with cystic fibrosis who received cadaveric bilateral lung transplantation. (B)–(G) Chest CT scan of the same patient. (B) Post-transplant day 215, when the patient was stable. (C) Post-transplant day 535, when the patient was recovering from the first episode of acute exacerbation. After steroid pulse and increased prednisone, function partially recovered with clearance of GGO, although interlobular septal thickening, interstitial reticular shadow and consolidation remained. (D) Post-transplant day 1,131, when the patient was recovering from the second exacerbation. Although his condition was relatively stable for 2 years after the second episode, the patient's CT scan showed gradual increases in interlobular septal thickening, interstitial reticular shadow and consolidation. He was listed for retransplantation. (E) Post-transplant day 374, when the patient underwent the first episode of acute exacerbation. CT scan showed extensive bilateral GGO, bilateral pneumothorax and pneumomediastinum. Transbronchial biopsies demonstrated DAD without evident rejection or infection. (F) Post-transplant day 817, when the patient had the second episode of acute exacerbation. CT scan showed reappearance of diffuse GGO with worsening interstitial shadows. (G) Post-transplant day 1,333, when the patient had the third episode of acute exacerbation. FEV1 declined further. CT scan showed further volume loss in the transplanted lungs, extensive GGO, and worsening consolidation and interlobular septal thickening. Arrows: time-point at which CT scan was taken; white arrows: acute exacerbation. The Journal of Heart and Lung Transplantation 2013 32, 23-30DOI: (10.1016/j.healun.2012.09.026) Copyright © 2013 International Society for Heart and Lung Transplantation Terms and Conditions

Figure 6 Representative case of RAS after lung transplantation: Case 3. (A) Post-transplant PFT changes in a 52-year-old man who received bilateral lung transplantation for IPF. (B)–(G) Chest CT scans of the same patient. (B) Post-transplant day 280, when the patient was stable. (C) 401 days post-transplant. (D) Post-transplant day 853, when the patient had the second episode of acute exacerbation. CT scan showed diffuse bilateral GGO, interstitial septal thickening and consolidation. (E) Post-transplant day 364, when the patient underwent the first episode of acute exacerbation. CT scan showed extensive GGO, reticular shadow, confluent airspace opacities and architectural distortion. Transbronchial biopsies showed DAD without rejection or infection. His general condition and PFTs and CT scans showed gradual improvement over the next 16 months. (F) 735 days post-transplant. (G) 883 days post-transplant. Although CT scan showed mild improvement in GGO 1 month later, his condition continued to deteriorate, and he died about 1 month after the second episode of acute exacerbation. Arrows: time-point at which the CT scan was taken; white arrows: acute exacerbation. The Journal of Heart and Lung Transplantation 2013 32, 23-30DOI: (10.1016/j.healun.2012.09.026) Copyright © 2013 International Society for Heart and Lung Transplantation Terms and Conditions