HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wang, J.-Y. Articles by Lee, Y.-C. Search for Related Content PubMed PubMed Citation Articles by Wang, J.-Y. Articles by Lee, Y.-C. Related Collections Lung - other

Ann Thorac Surg 2004;78:267-272
© 2004 The Society of Thoracic Surgeons

---

Original article: general thoracic

Diffuse pulmonary infiltrates after bone marrow transplantation: the role of open lung biopsy

^a Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
^c Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
^d Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
^e Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
^b Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan

Accepted for publication January 7, 2004.

^* Address reprint requests to Dr Yung-Chie Lee, Department of Surgery, National Taiwan University Hospital, No 7, Chung-Shan South Rd, Taipei, Taiwan
e-mail: twin901119{at}yahoo.com.tw

BACKGROUND: Diffuse pulmonary infiltrates is the major complication and cause of mortality after bone marrow transplantation. We analyzed the etiologies and prognostic factors in bone marrow recipients with diffuse pulmonary infiltrates and assessed the role of open lung biopsy in managing this complication.

METHODS: Medical records of patients with diffuse pulmonary infiltrates after bone marrow transplantation were reviewed. Possible prognostic factors were analyzed by multivariate logistic regression.

RESULTS: Sixty-eight (20%) of 341 bone marrow recipients had diffuse pulmonary infiltrates and 34 died. Thirty-five underwent open lung biopsy, resulting in therapeutic changes in 22 (63%) and clinical improvement in 16 (46%). The leading diagnoses were idiopathic interstitial pneumonitis (40%) and cytomegalovirus pneumonitis (20%). Cytomegalovirus pneumonitis caused radiographically observable interstitial infiltrates exclusively and was frequently associated with hepatitis. Idiopathic interstitial pneumonitis resulted in either diffuse ground-glass opacity or interstitial infiltrates. Three (9%) patients had miliary tuberculosis. Respiratory failure (p < 0.001) and acute graft-versus-host disease (p = 0.016) were the poor prognostic factors.

CONCLUSIONS: Among bone marrow recipients, we found diffuse pulmonary infiltrates in 20% and a mortality rate of 50%. Idiopathic interstitial pneumonitis and cytomegalovirus pneumonitis were the most common causes and should be suspected in patients with diffuse interstitial infiltrates. In endemic areas, miliary tuberculosis should be suspected in bone marrow recipients with diffuse reticulonodular lesions. Respiratory failure and acute graft-versus-host disease were poor prognostic factors. By establishing a correct diagnosis, open lung biopsy led to treatment changes in about two-thirds of these patients.

This article has been cited by other articles:

				Y.-C. Lee, C.-T. Wu, H.-H. Hsu, P.-M. Huang, and Y.-L. Chang Surgical lung biopsy for diffuse pulmonary disease: Experience of 196 patients J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 984 - 990. [Abstract] [Full Text] [PDF]