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
HSCT: In this setting, BOS refers to new-onset obstructive pulmonary dysfunction
Histologically identical to BOS after lung transplantation
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
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
HSCT: In this setting, BOS refers to new-onset obstructive pulmonary dysfunction
Histologically identical to BOS after lung transplantation
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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