22 - Imaging

Summary

Introduction

The expected radiological appearances and potential surgical complications of lung transplantation vary depending on the type of transplantation that has been performed(see Chapters 13 and 14). Whereas the appearances of medical complications such as rejection, infection and malignancy are common to all types of lung transplant. Some findings are unique to lung transplantation whereas others are related to the effects of cardiothoracic surgery in general. Radiological investigation may provide a specific diagnosis but many pulmonary complications have a nonspecific appearance and their differential diagnosis must be established from the clinical context and from laboratory investigation (see Chapters 20, 21 and 23). Therefore close correlation with time-related clinical and pathological findings is essential.

Postoperative complications

Early complications of lung transplant surgery include haemothorax, pneumothorax, effusion, infection and wound complications.

Haemothorax

This is usually related to surgical bleeding, which is more likely to occur in patients who have undergone previous surgery and those who underwent cardiopulmonary bypass as part of the surgical procedure. Computed tomography (CT) of the chest can localize the extent of a haemothorax and define any underlying parenchymal abnormality.

Pneumothorax

This may occur in all types of lung transplantation and was found in 10% of one series of 138 patients [1]. In heart-lung transplantation it may be bilateral due to the communication between the two pleural spaces; in bilateral sequential lung transplantation performed through an anterior clam shell incision, a similar communication between the pleural spaces occurs anteriorly. Postoperative pneumothoraces may be therefore be unilateral, bilateral and may shift between sides with changes in the patient's posture.