Role of HRCT Chest in Post Stem Cell Transplant Recipients Suspected of Pulmonary Complications.

Abstract

Stem cell transplantation is today's procedure of choice for management of various hematopoietic malignant and severe immunogenic disorders. High Resolution Computed Tomography (HRCT) is a common technique for the diagnosis of pulmonary complications in stem cell transplant recipients. There are a large number of complications which can complicate the post-transplant period. To study the role of HRCT chest in stem cell transplant patients developing pulmonary complications, detect any evidence of infection, detect clinical signs of lung infections, Graft versus Host Disease (GvHD) or other regimen related toxicities outlined earlier, detect any evidence of GvHD and correlate these clinical signs with radiological changes in the lungs. The study was a prospective study of 52 participants with indication of stem cell transplantation. The study included recipients of HSCT transplant and the exclusion criteria was patients who failed for engraftment and having an associated history of pulmonary embolism. Patients were screened for pre-transplant chemotherapy, clinical examination, laboratory investigations including blood and biochemical examinations, imaging by ultrasound, chest radiography, baseline HRCT and a follow-up for post-transplant infections and complications with 16 slice Siemens CT scan. Statistical analysis was done using Pearson's chi-squared test. Four patients among the total 56 were excluded due to non-engraftment. The most common associated findings in decreasing order are (these patients died): consolidation, pancytopenia and gastrointestinal tract symptoms with VOD (Veno-Occlusive Disease). These findings were seen on HRCT as consolidation, cavities, ground glass opacities, fibrotic changes, bronchiectatic changes and tree in bud appearance. The study highlights the significant positive findings on the HRCT which were missed on routine chest radiograph and can be used for early diagnoses. Thus, HRCT helped in decreasing the mortality. The abnormal vitals and TLC counts showed a significant relation between the numbers of death in the study.