J Korean Soc Radiol.  2016 Aug;75(2):151-156. 10.3348/jksr.2016.75.2.151.

Thoracic Air-Leakage Syndrome in Allogeneic Stem Cell Transplant Recipients as a Late Complication of Chronic Graft-versus-Host Disease: Case Reports

• Park JW
• Kim SS
• Jo DY
• Yun HJ
• Lee HJ
• Kim JH

• KMID: 2344807
• DOI: http://doi.org/10.3348/jksr.2016.75.2.151

Abstract

Air-leakage syndrome associated with graft-versus-host disease (GVHD) is a rare complication, but it is also reported as an independent predictor of a worse survival rate after stem cell transplantation. We report two cases of air-leakage syndrome associated with GVHD after allogeneic stem cell transplantation in acute leukemia patients who presented with spontaneous pneumomediastinum and subcutaneous emphysema, and finally death due to respiratory failure seven to eight months later.

MeSH Terms

Bronchiolitis Obliterans
Graft vs Host Disease*
Hematopoietic Stem Cell Transplantation
Humans
Leukemia
Mediastinal Emphysema
Respiratory Insufficiency
Stem Cell Transplantation
Stem Cells*
Subcutaneous Emphysema
Survival Rate
Transplant Recipients*

Figure

• 

  Fig. 1 A 20-year-old man underwent related allogeneic stem cell transplantation (Allo-SCT) for acute myeloid leukemia. A. One and a half years after Allo-SCT, a plain chest radiograph shows subcutaneous emphysema in the neck and upper trunk and pneumomediastinum. Patchy ground-glass opacities (GGO) along the bronchovascular bundles are also noted in both lungs. B-D. Chest CT scans show extensive subcutaneous emphysema in the neck and chest wall, pneumomediastinum and pneumorachis. Multifocal patchy GGOs, bronchiectasis, as well as a mosaic pattern of attenuations mixed with paucity of regional pulmonary vasculature in both lower lobes suggest a bronchiolitis obliterans component. Radiolucent air around the segmental pulmonary artery and bronchus in the right lower lobe, suggesting pulmonary interstitial emphysema (arrows in C) is also noted. CT = computed tomography

• 

  Fig. 2 A 58-year-old man underwent related allogeneic stem cell transplantation (Allo-SCT) for acute lymphoid leukemia. A. Approximately three years after Allo-SCT, bilateral diffuse tubular bronchiectasis mixed with a mosaic pattern of lung attenuation and paucity of pulmonary vessels in the radiolucency area (air trapping) suggesting bronchiolitis obliterans are noted in both lower lobes on chest CT. B, C. One and a half years later, newly developed pneumomediastinum and subcutaneous emphysema are noted in the lower neck and the upper thoracic cage. Bilateral diffuse tubular bronchiectasis and radiolucency of air trapping suggesting bronchiolitis obliterans are still noted in both sides of the lungs. Localized cystic bronchiectasis is also noted in the anterior segment of the right upper lobe. CT = computed tomography

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