High-resolution CT in renal transplant patients with suspected pulmonary infections

Objective: This prospective study was carried out to assess the usefulness of high-resolution CT (HRCT) of the chest in immunocompromised renal transp lant patients with suspected pulmonary infections. Material and Methods: Twenty-one consecutive renal transplant patients with clinically suspected pulmonary infections underwent chest radiography, HRC T and other tests including bronchoalveolar lavage (BAL). HRCT was performe d using a high spatial frequency algorithm with 2-mm-thick sections at IO-m m intervals from apices to domes of the diaphragm. The findings on chest ra diography and HRCT were interpreted by two thoracic radiologists and the us efulness of HRCT was evaluated. The images were interpreted independently b y two radiologists, who were blinded to the findings of other imaging modal ities and the final diagnosis. Any differences regarding the imaging findin gs were resolved through consensus. Results. Final diagnosis was obtained in 17 patients, and no cause for symp tomatology was established in 4 patients. The spectrum of infections includ ed pulmonary tuberculosis (TB) in 11 patients, cytomegalovirus pneumonia (C MV) in 2 patients, cryptococcal and streptococcal pneumonia, pulmonary aspe rgillosis and esophageal candidiasis in 1 patient each. Compared to chest r adiography, HRCT revealed additional findings in 11 patients. HRCT findings were suggestive of underlying infection in 11 patients. The final diagnosi s coincided with HRCT diagnosis in all but 1 patient. HRCT findings were no nspecific in 3 patients and normal in 7. The findings were concordant in 19 cases. The results were not in agreement in only 2 cases. Conclusion: HRCT can provide useful information and suggest the diagnosis i n a significant proportion of renal transplant patients with pulmonary infe ction.