Air-leak syndromes in hematopoietic stem cell transplant recipients with chronic GVHD: high-resolution CT findings

J Thorac Imaging. 2007 Nov;22(4):335-40. doi: 10.1097/RTI.0b013e3180cab6cf.


Objectives: The purpose of this study was to determine the incidence and the high-resolution computed tomography findings of air-leak syndromes in a large group of hematopoietic stem cell (HSC) transplant recipients with proved chronic graft versus host disease (cGVHD).

Materials and methods: High-resolution computed tomography scans of 9 allogeneic HSC transplant recipients (8 men, 1 woman; 19 to 45 years of age; median 28 y), with a proven diagnosis of cGVHD-related bronchiolitis obliterans syndrome (BOS) were reviewed for the presence, appearance, and distribution of abnormalities.

Results: Nine patients with cGVHD developed 10 episodes of spontaneous air-leak syndromes secondary to cGVHD-related BOS during the study period analyzed; for a 2-year estimated cumulative incidence of 2.1% (95% confidence interval 0.2% to 3.8%) its prevalence was 5.7% (95%CI: 2.6% to 10.5%). All cases were allogeneic HSC transplant recipients with cGVHD who acquired new respiratory symptoms and/or radiologic abnormalities. Pneumomediastinum and pneumothorax were present in 6 patients. Subcutaneous emphysema was identified in 3 patients and pulmonary interstitial emphysema in 2 patients. A combination of different air-leak syndromes was observed in 6 patients.

Conclusion: Air-leak syndromes represent an uncommon late complication in HSC transplant recipients with cGVHD-related BOS.

MeSH terms

  • Adult
  • Bronchiolitis Obliterans / diagnostic imaging*
  • Bronchiolitis Obliterans / etiology*
  • Chronic Disease
  • Female
  • Graft vs Host Disease / complications*
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Prevalence
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Subcutaneous Emphysema / diagnostic imaging*
  • Subcutaneous Emphysema / epidemiology
  • Subcutaneous Emphysema / etiology*
  • Syndrome
  • Tomography, X-Ray Computed / methods*