Graft-versus-host disease chest x ray

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]

Overview

A chest X-ray can be done to evaluate for pneumonitis, which can be a manifestation of pulmonary GvHD. A variety of radiographic features can be seen.

Chest X-Ray

A chest X-ray can be done to assess for immune attack in the lungs, such as pneumonitis. Pneumonitis is a less common GvHD manifestation compared to rash, liver dysfunction, and diarrhea. However, pneumonitis has been known to occur. Pneumonitis presents radiographically as a nodular or interstitial pattern. There can be inflammation in the peri-bronchiolar tissue, resulting in variable areas of hyperdensity and hypodensity on the chest X-ray. Ground glass appearance and consolidative opacities can also be seen.^[1] CT scan of the chest can better diagnose pneumonitis.

A chest X-ray is also an important diagnostic tool in the evaluation of other stem cell transplant-related conditions, such as pneumonia, volume overload, transfusion-related acute lung injury (TRALI). Chest X-ray can help differentiate pulmonary GvHD from these conditions. Volume overload and transfusion-related acute lung injury (TRALI) will show blunting of the costophrenic angles and pulmonary vascular engorgement, reflecting excess fluid in the lungs.

References

↑ Nishino M, Boswell EN, Hatabu H, Ghobrial IM, Ramaiya NH (2015). “Drug-Related Pneumonitis During Mammalian Target of Rapamycin Inhibitor Therapy: Radiographic Pattern-Based Approach in Waldenström Macroglobulinemia as a Paradigm”. Oncologist. 20 (9): 1077–83. doi:10.1634/theoncologist.2015-0033. PMC 4571812. PMID 26205737.

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[pmid26205737-1] Nishino M, Boswell EN, Hatabu H, Ghobrial IM, Ramaiya NH (2015). “Drug-Related Pneumonitis During Mammalian Target of Rapamycin Inhibitor Therapy: Radiographic Pattern-Based Approach in Waldenström Macroglobulinemia as a Paradigm”. Oncologist. 20 (9): 1077–83. doi:10.1634/theoncologist.2015-0033. PMC 4571812. PMID 26205737.

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