Терапевтический архив (Apr 2004)
Potentialities of high-resolution computed tomography in diagnosis of pulmonary lesions after bone marrow transplantation in blood diseases
Abstract
Aim. To study characteristics of a skialogical picture of pulmonary parenchyma and roentgenomorphological signs of inflammatory changes before and after bone marrow transplantation (BMT); relationship between the data of high-resolution computed tomography (HRCT) and clinical data. Material and methods. HRCT (computer tomograph of the third generation "Somatom CR-3") was made in fever, changes in physical examination in patients (n = 28) after BMTfrom November 200] to January 2003. BMT was made in myelomic disease, lymphogranulomatosis, acute leukemia, chronic myeloid leukemia, lymphosarcoma, autoimmune hemolytic anemia. Results. Twenty four patients were examined before BMT. Of them, 18 patients had roentgenomorphological changes of the parenchyma, primarily, diffuse. Three patients were examined during conditioning, two cases had signs of toxic pulmonitis. One day after allo-BMT all the patients exhibited lowering of densitometric values of pulmonary tissue by 70 HU vs the baseline. Infectious affection of the lungs was diagnosed in 13 cases during day 0-100. From day 100 after allo-BMT 7 recipients were observed. In 6 cases the changes resulted from transplant against host reaction. Infectious affection of pulmonary tissue was observed in 1 case. Characteristic x-ray picture of pulmonary stroma In secondary disease was determined. Conclusion. For early diagnosis of pneumonia in myelotoxic agranulocytosis it is necessary to make examination by HRCT before BMT. HRCT of the chest is indicated in even minor changes in the clinical picture. It is necessary to perform a control over water-electrolyte balance and active respiratory exercise in the course of conditioning. Viral pneumonias show the picture of metainflammatory changes for a long time. Fungal pneumonias tend to recurrence at "previous site". HRCT examination of the pulmonary tissue provides more information about pulmonary tissue in patients with secondary disease.
