Lung nodular lesions in heart transplant recipients

Purpose: To describe the characteristics and etiology of lung nodules after hearttransplantation (HT). Patients and Methods: During a 6-year period 147 patients received HT and 1 30 survived more than 1 week. Nodular lesions were demonstrated after HT in 13 patients (10%). Results: Median age was 53 years, and all patients were male. Nodules were detected 23 to 158 days after HT (median, 66 days). An etiologic diagnosis was made in all but 1 case: Aspergillus (5), Nocardia-Rhodococcns (4), and cytomegalovirus (CMV) (3). Previous severe infection was present in 50% of the patients and rejection in 33% (75% with nocardiosis). Initially all pat ients with Nocardia but only 1 patient with aspergillosis were asymptomatic . The most common symptoms were fever (67%) and cough (50%). Central nervou s system (CNS) involvement appeared in only one Aspergillus-infected patien t. An average of 1.8 diagnostic procedures per patient were performed. Medi an time to establish a diagnosis was 8 days (0 to 24). Median hospital stay was 36 days and reached 60 in patients with Aspergillus, No patient died, although aspergillosis, which must be suspected in the presence of dyspnea, pleuritic pain, and CNS symptoms, caused the highest morbidity. Overall di agnostic yield was 60% for transtracheal aspiration, 70% for bronchoalveola r lavage, and 75% for transthoracic aspiration. Conclusions: Ten percent of HT patients developed lung nodules that were ma inly caused by Aspergillus, Nocardia, and CMV. The time of appearance and s ome clinical manifestations may suggest the etiology and may help in the em pirical treatment.