Pulmonary hypertension associated with pulmonary occlusive vasculopathy after allogeneic bone marrow transplantation.
BACKGROUND
Pulmonary vasculature abnormalities, including pulmonary veno-occlusive disease, have been demonstrated in marrow allograft recipients. However, it is often difficult to make a correct diagnosis of pulmonary lesions.


METHODS
An open lung biopsy was performed on a patient who developed severe pulmonary hypertension after bone marrow transplantation for T-cell lymphoma.


RESULTS
An open lung biopsy specimen demonstrated pulmonary arterial occlusion due to intimal fibrosis and veno-occlusion. The most striking alteration was partial to complete occlusion of the small arteries by fibrous proliferation of the intima.


CONCLUSIONS
High-dose preparative chemotherapy and radiation before transplantation are thought to have contributed to the development of vasculopathy in this patient, because arterial occlusion by intimal fibrosis and atypical veno-occlusion are often associated with lung injury due to chemoradiation. An open lung biopsy is essential for diagnosing pulmonary vascular disease presenting signs compatible with posttransplantation pulmonary hypertension.
Seguchi
M
M
Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Japan.
Hirabayashi
N
N
Fujii
Y
Y
Azuno
Y
Y
Fujita
N
N
Takeda
K
K
Sato
Y
Y
Nishimura
M
M
Yamada
K
K
Oka
Y
Y
D000328:Adult; D016026:Bone Marrow Transplantation; D005355:Fibrosis; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology*; D016399:Lymphoma, T-Cell / Q000601:surgery; D008297:Male; D011183:Postoperative Complications; D011652:Pulmonary Circulation; D014184:Transplantation, Homologous; D017539:Tunica Intima / Q000473:pathology; D014652:Vascular Diseases / Q000209:etiology* / Q000473:pathology