title: Spontaneous thoracic air-leakage syndrome in patients following allogeneic hematopoietic stem cell transplantation: causes, CT-follow up and patient outcome.
abstract: OBJECTIVE
  The purpose of this article is to describe and illustrate the acute and follow-up imaging features, clinical constellation and outcome of patients with thoracic air-leakage syndrome following allogeneic hematopoietic stem cell transplantation (allo-HCT).
  
  
  METHODS
  Patients with evidence of thoracic air-leakage, i.e. spontaneous pneumomediastinum, spontaneous pneumothorax or interstitial emphysema after allo-HCT were retrospectively identified by a chart review. Acute and follow-up morphology, duration and patient outcome were analyzed on CT (HRCT or MSCT with HR-reconstructions). Correlation was made with histological results of transbronchial biopsy.
  
  
  RESULTS
  The 6 patients included (3 male and 3 female, 14-64 years old) with thoracic air-leakage after allo-HCT all had histologically proven bronchiolitis obliterans (BO) or bronchiolitis obliterans organizing pneumonia (BOOP). Thoracic air-leakage consisted of spontaneous pneumomediastinum associated with active invasive pulmonary aspergillosis (IPA) in 4/6 and spontaneous pneumothorax or interstitial emphysema each in 1/6 patients. Duration of thoracic air-leakage was 7-135 days. Of the patients with spontaneous pneumomediastinum, 3/4 died of IPA. One patient survived until complete regression of spontaneous pneumomediastinum. One patient died 7 days after spontaneous pneumothorax and one survived developing chronic interstitial emphysema.
  
  
  CONCLUSIONS
  In all cases, thoracic air-leakage was associated to BO or BOOP. In the majority of cases with additional IPA, thoracic air-leakage is more indicative for severity of pulmonary disease than a life-threatening entity itself.
authors.affiliation: Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany. monika.vogel@med.uni-tuebingen.de <monika.vogel@med.uni-tuebingen.de>
authors.forename: Monika
authors.initials: M
authors.lastname: Vogel
authors.forename: Harald
authors.initials: H
authors.lastname: Brodoefel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bethge
authors.forename: Christoph
authors.initials: C
authors.lastname: Faul
authors.forename: Jörg
authors.initials: J
authors.lastname: Hartmann
authors.forename: Heiko
authors.initials: H
authors.lastname: Schimmel
authors.forename: Manfred
authors.initials: M
authors.lastname: Wehrmann
authors.forename: Claus D
authors.initials: CD
authors.lastname: Claussen
authors.forename: Marius
authors.initials: M
authors.lastname: Horger
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001989:Bronchiolitis Obliterans / Q000150:complications / Q000401:mortality / Q000628:therapy*; D018549:Cryptogenic Organizing Pneumonia / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D013352:Subcutaneous Emphysema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome