Solitary pulmonary nodule in the liver transplant candidate: importance of diagnosis and treatment.
Our objectives were to define the incidence and etiology of solitary pulmonary nodules (SPNs) in patients undergoing living donor liver transplantation (LDLT), describe a diagnostic approach to the management of SPNs in LDLT, and define the impact of SPNs on the overall survival of adult LDLT recipients. Nine patients (9/152, 5.9%) were diagnosed with an SPN on the basis of chest radiography findings during the pretransplant survey. All were male. The mean age was 52 years. All the patients had hepatitis B virus-related cirrhosis with hepatocellular carcinoma. All were asymptomatic for the lung lesion. All underwent contrast-enhanced chest computed tomography (CT) to verify the presence and possible etiology of the SPNs. In 3 cases, CT was used to definitely determine that there was no pulmonary nodule; in 2, CT led to a definite diagnosis of pulmonary tuberculosis. In 4, CT led to a definite identification of an SPN but not to an etiological diagnosis. Two patients underwent outright thoracoscopy and biopsy of their SPNs. Biopsy showed cryptococcosis in both patients. One received a therapeutic trial of an antituberculosis treatment, and repeat CT after 1 month showed a regression in the size of the SPN. A diagnosis of tuberculosis was made. One patient had an inconclusive whole body positron emission tomography scan and subsequently underwent thoracoscopy where biopsy showed tuberculosis. A concomitant malignancy, either primary lung cancer or metastasis from the liver tumor, was not identified. All patients were surviving with their original grafts and were lung infection-free. The overall mean posttransplant follow-up was 54 months (range = 33-96 months).
Concejero
Allan M
AM
Liver Transplantation Program, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan.
Yong
Chee-Chien
CC
Chen
Chao-Long
CL
Lu
Hung-I
HI
Wang
Chih-Chi
CC
Wang
Shih-Ho
SH
Liu
Yueh-Wei
YW
Yang
Chin-Hsiang
CH
Cheng
Yu-Fan
YF
Jawan
Bruno
B
D000935:Antifungal Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D001706:Biopsy; D002985:Clinical Protocols; D003287:Contrast Media; D003453:Cryptococcosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D013624:Taiwan; D013906:Thoracoscopy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy
D000935:Antifungal Agents; D000995:Antitubercular Agents; D003287:Contrast Media