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Bronchial stenosis - lung transplant

Case contributed by Bruno Di Muzio
Diagnosis certain

Presentation

2 years post bilateral lung transplant. Drop in lung function in the last months (FEV1 1.6 L). VQ scan showing matched severe reduction in ventilation and perfusion in the left lung

Patient Data

Age: 70 years
Gender: Male

Chest

ct

There are patchy centrilobular ground-glass opacities within the left lower lobe supportive of distal airways infection. Left lung air-trapping secondary to the known left main bronchus stenosis. Otherwise, no significant bronchiectasis or air trapping to support chronic rejection.  The pleural spaces are clear.

There is no hilar, mediastinal, axillary lymphadenopathy.  The thoracic cage and imaged superior abdomen are unremarkable.

Conclusion:
1. Left lower lobe distal airways infective changes are etiology nonspecific.
2. No evidence of chronic lung allograft dysfunction.
3. Left main bronchus stenosis is similar.

Case Discussion

There are no features to suggest BOS/CLAD. Narrowing in the main left bronchus results in complete left lung air-trapping and is in keeping to narrowing at the level of the anastomosis. 

This was managed with main bronchus dilatation with a balloon and stent placement. 

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