If a CT-guided transthoracic biopsy is planned, the interventionalist can also use the preprocedural CT to determine the optimal patient position and biopsy route. Variant 4: Acute respiratory illness in immunocompromised patients. Abnormal chest radiograph, noninfectious disease suspected. Next imaging study. CT Chest Further investigation with CT is warranted in immunocompromised patients with ARI who have chest radiographs suspected. Immunosuppressed patients are susceptible to a variety of noninfectious pulmonary diseases. Because of its superior spatial resolution and cross-sectional display of findings, CT provides enhanced characterization of pulmonary parenchymal abnormalities, which may assist in formulating a differential diagnosis. Noninfectious causes of ARI in immunocompromised hosts include pulmonary edema, drug-induced lung disease, atelectasis, malignancy (including post-transplant lymphoproliferative disorder), radiation-induced lung disease, pulmonary hemorrhage, diffuse alveolar damage, organizing pneumonia, lung transplant rejection, graft-versus-host disease, and pulmonary thromboembolic disease [2]. For example, many chemotherapeutic and immunomodulatory agents may result in pulmonary toxicity [40]. CT is more sensitive than chest radiography in detecting drug-induced lung injury from agents such as bleomycin, busulfan, carmustine, and cyclophosphamide [40,41]. In patients with a history of pulmonary malignancy, recurrence of the primary tumor or development of lung metastases should always be considered when chest radiography shows nodular opacities; similarly, metastases from an ARI in Immunocompromised Patients extrathoracic primary often manifest as nodules. An organizing pneumonia pattern of lung injury is a well-known complication in immunocompromised patients, particularly as a manifestation of lung transplant rejection and chronic graft-versus-host disease following allogeneic hematopoietic stem cell transplantation [42-44].
Acute Respiratory Illness in Immunocompromised Patients. If a CT-guided transthoracic biopsy is planned, the interventionalist can also use the preprocedural CT to determine the optimal patient position and biopsy route. Variant 4: Acute respiratory illness in immunocompromised patients. Abnormal chest radiograph, noninfectious disease suspected. Next imaging study. CT Chest Further investigation with CT is warranted in immunocompromised patients with ARI who have chest radiographs suspected. Immunosuppressed patients are susceptible to a variety of noninfectious pulmonary diseases. Because of its superior spatial resolution and cross-sectional display of findings, CT provides enhanced characterization of pulmonary parenchymal abnormalities, which may assist in formulating a differential diagnosis. Noninfectious causes of ARI in immunocompromised hosts include pulmonary edema, drug-induced lung disease, atelectasis, malignancy (including post-transplant lymphoproliferative disorder), radiation-induced lung disease, pulmonary hemorrhage, diffuse alveolar damage, organizing pneumonia, lung transplant rejection, graft-versus-host disease, and pulmonary thromboembolic disease [2]. For example, many chemotherapeutic and immunomodulatory agents may result in pulmonary toxicity [40]. CT is more sensitive than chest radiography in detecting drug-induced lung injury from agents such as bleomycin, busulfan, carmustine, and cyclophosphamide [40,41]. In patients with a history of pulmonary malignancy, recurrence of the primary tumor or development of lung metastases should always be considered when chest radiography shows nodular opacities; similarly, metastases from an ARI in Immunocompromised Patients extrathoracic primary often manifest as nodules. An organizing pneumonia pattern of lung injury is a well-known complication in immunocompromised patients, particularly as a manifestation of lung transplant rejection and chronic graft-versus-host disease following allogeneic hematopoietic stem cell transplantation [42-44].