Transplantation |

New Nodules-Newer Etiology FREE TO VIEW

Sami Abuqayyas, MD; Juan Wang, MD; Puneet Garcha, MBBS; Charles Lane, MD; Wayne Tsuang, MD; Marie Budev, DO; Olufemi Akindipe, MD; Atul Mehta, MBBS
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Cleveland Clinic-Internal Medicine, Cleveland, OH

Chest. 2015;148(4_MeetingAbstracts):1085A. doi:10.1378/chest.2243709
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SESSION TITLE: Transplantation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Peripheral pulmonary nodule (PPN) is a common clinical challenge. This entity is even more challenging when detected in lung transplant recipients (LTR). Flexible bronchoscopy (FB) is routinely performed following lung transplantation. We incidentally noted development of new PPN in LTR following a FB with a transbronchial biopsy (TBBx). This finding has a potential to initiate unnecessary diagnostic work-up. Purpose of our study was to evaluate frequency and the temporal relationship between the nodule and the TBBx among the LTR, with an intention to avoid unwarranted testing.

METHODS: We retrospectively reviewed 100 records of LTR who underwent FB with TBBx, looking for the appearance of PPN. If these patients had chest radiographs within 50 days of FB, they were included in the study. Data was compared with 30 procedures performed among non-transplant patients. Information on patient’s demographics, antirejection medications, anticoagulation, indication and type of lung transplantation, timing of the FB and the appearance and disappearance of the nodules and its characteristics were gathered.

RESULTS: 19 new PN were found in 13 procedures performed on LTR and none among non-transplant patients. Nodules were detected between 4-47 days from the procedure and disappeared within 84 days after appearance without intervention

CONCLUSIONS: FB in LTR is associated with development of new, transient PPN at the site of TBBx in 13% of procedures. We hypothesize that these nodules are related to local hematoma and impaired lymphatic drainage. Close observation is a reasonable management approach

CLINICAL IMPLICATIONS: All physicians involved in caring for LTRs should be cognizant of this newer iatrogenic etiology of a PPN. The awareness will avoid unnecessary, expensive work up in this unique group of patients

DISCLOSURE: The following authors have nothing to disclose: Sami Abuqayyas, Juan Wang, Puneet Garcha, Charles Lane, Wayne Tsuang, Marie Budev, Olufemi Akindipe, Atul Mehta

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