Imaging of cardiac transplantation complications

Common complications of cardiac transplantation include infection, rejectio n, accelerated coronary artery atherosclerosis, and lymphoproliferative dis ease. The authors reviewed radiographic and computed tomographic (CT) featu res of cardiac transplantation and its complications in a series of 232 pat ients (with 89 complications and 49 deaths). Normal postoperative findings in the first few weeks after surgery included enlarged cardiac silhouette, pneumomediastinum, pneumothorax, pneumopericardium, subcutaneous emphysema, and mediastinal widening. Infection was the most common complication, with pneumonia being the leading infectious condition (28 cases, with Aspergill us [n = 11] and cytomegalovirus [n = 10] being the most common pathogens) a nd the cause of death in seven cases. Although many cases of pulmonary infe ctions occur in the first 3-4 months after surgery, in this series several cases developed up to 3 years afterward. Radiographic signs of acute reject ion were nonspecific in the eight patients affected who died, and endomyoca rdial biopsy was used to confirm the suspected diagnosis. Accelerated ather osclerosis occurred in 13 patients between 10 months and 6.5 years after tr ansplantation and led to death in eight. Lymphoproliferative disorders, whi ch range from benign lymphoid hyperplasia to malignant lymphoma and which a re the third leading cause of death beyond the immediate perioperative peri od in heart transplant: recipients, developed in four patients who later di ed. Other complications related to endomyocardial biopsy and cardiothoracic surgery (ie, pneumothorax, hemothorax, pneumomediastinum, mediastinitis, a ortic dissection, aortic pseudoaneurysm, and pulmonary embolism) occurred i n 31 cases and were diagnosed with radiography and CT.