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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
- Lung transplantation
- Chronic lung allograft dysfunction (CLAD)
- Bronchiolitis obliterans syndrome (BOS)
- Restrictive allograft syndrome (RAS)
- Neutrophilic reversible allograft dysfunction (NRAD)
- Fibrous BOS (fBOS)
- Hematopoietic stem cell transplantation (HSCT): BOS, graft-vs.-host disease (GVHD)
- Diffuse alveolar damage (DAD)
- Lung transplantation
Definitions
- BOS: Broadly used and well-known term; often incorrectly used to signify chronic rejection
- Evolving evidence shows that BOS is a form of CLAD
- CLAD: Broad term describing spectrum of heterogeneous chronic lung abnormalities in lung transplant recipients
- Phenotypes
- RAS: Restrictive pulmonary function
- Late new-onset DAD (> 3 months post transplantation) suggests near-future development of RAS
- BOS: Includes chronic rejection but alloimmune independent factors (gastroesophageal reflux, aspiration, and infection) contribute to pathogenesis
- NRAD: Allograft dysfunction characterized by reversible airway neutrophilia responsive to azithromycin
- fBOS: BOS subtype not responsive to azithromycin
- RAS: Restrictive pulmonary function
- Phenotypes
- HSCT: In this setting, BOS refers to new-onset obstructive pulmonary dysfunction
- Histologically identical to BOS after lung transplantation
- BOS: Broadly used and well-known term; often incorrectly used to signify chronic rejection
IMAGING
General Features
Radiographic Findings
CT Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- Royer PJ et al: Chronic lung allograft dysfunction: A systematic review of mechanisms. Transplantation. 100(9):1803-14, 2016
- Jagasia MH et al: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group Report. Biol Blood Marrow Transplant. ePub, 2014
- Meyer KC et al: An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome. Eur Respir J. 44(6):1479-503, 2014
- Bergeron A et al: Bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: phenotypes and prognosis. Bone Marrow Transplant. 48(6):819-24, 2013
- Sato M: Chronic lung allograft dysfunction after lung transplantation: the moving target. Gen Thorac Cardiovasc Surg. 61(2):67-78, 2013
- Verleden SE et al: Neutrophilic reversible allograft dysfunction (NRAD) and restrictive allograft syndrome (RAS). Semin Respir Crit Care Med. 34(3):352-60, 2013
- de Jong PA et al: Thin-section computed tomography findings before and after azithromycin treatment of neutrophilic reversible lung allograft dysfunction. Eur Radiol. 21(12):2466-74, 2011
- Todd JL et al: Bronchiolitis obliterans syndrome: the final frontier for lung transplantation. Chest. 140(2):502-8, 2011
- Gunn ML et al: High-resolution CT findings of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. J Thorac Imaging. 23(4):244-50, 2008
- Konen E et al: Bronchiolitis obliterans syndrome in lung-transplant recipients: can thin-section CT findings predict disease before its clinical appearance? Radiology. 231(2):467-73, 2004
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
- Lung transplantation
- Chronic lung allograft dysfunction (CLAD)
- Bronchiolitis obliterans syndrome (BOS)
- Restrictive allograft syndrome (RAS)
- Neutrophilic reversible allograft dysfunction (NRAD)
- Fibrous BOS (fBOS)
- Hematopoietic stem cell transplantation (HSCT): BOS, graft-vs.-host disease (GVHD)
- Diffuse alveolar damage (DAD)
- Lung transplantation
Definitions
- BOS: Broadly used and well-known term; often incorrectly used to signify chronic rejection
- Evolving evidence shows that BOS is a form of CLAD
- CLAD: Broad term describing spectrum of heterogeneous chronic lung abnormalities in lung transplant recipients
- Phenotypes
- RAS: Restrictive pulmonary function
- Late new-onset DAD (> 3 months post transplantation) suggests near-future development of RAS
- BOS: Includes chronic rejection but alloimmune independent factors (gastroesophageal reflux, aspiration, and infection) contribute to pathogenesis
- NRAD: Allograft dysfunction characterized by reversible airway neutrophilia responsive to azithromycin
- fBOS: BOS subtype not responsive to azithromycin
- RAS: Restrictive pulmonary function
- Phenotypes
- HSCT: In this setting, BOS refers to new-onset obstructive pulmonary dysfunction
- Histologically identical to BOS after lung transplantation
- BOS: Broadly used and well-known term; often incorrectly used to signify chronic rejection
IMAGING
General Features
Radiographic Findings
CT Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- Royer PJ et al: Chronic lung allograft dysfunction: A systematic review of mechanisms. Transplantation. 100(9):1803-14, 2016
- Jagasia MH et al: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group Report. Biol Blood Marrow Transplant. ePub, 2014
- Meyer KC et al: An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome. Eur Respir J. 44(6):1479-503, 2014
- Bergeron A et al: Bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: phenotypes and prognosis. Bone Marrow Transplant. 48(6):819-24, 2013
- Sato M: Chronic lung allograft dysfunction after lung transplantation: the moving target. Gen Thorac Cardiovasc Surg. 61(2):67-78, 2013
- Verleden SE et al: Neutrophilic reversible allograft dysfunction (NRAD) and restrictive allograft syndrome (RAS). Semin Respir Crit Care Med. 34(3):352-60, 2013
- de Jong PA et al: Thin-section computed tomography findings before and after azithromycin treatment of neutrophilic reversible lung allograft dysfunction. Eur Radiol. 21(12):2466-74, 2011
- Todd JL et al: Bronchiolitis obliterans syndrome: the final frontier for lung transplantation. Chest. 140(2):502-8, 2011
- Gunn ML et al: High-resolution CT findings of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. J Thorac Imaging. 23(4):244-50, 2008
- Konen E et al: Bronchiolitis obliterans syndrome in lung-transplant recipients: can thin-section CT findings predict disease before its clinical appearance? Radiology. 231(2):467-73, 2004
