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Chest radiography in pediatric allogeneic bone marrow transplantation

Pulmonary complications in children receiving allogeneic bone marrow transplants are frequent and produce complex and confusing chest radiographic abnormalities. A simplified approach to the interpretation of the latter is presented. The development of patchy, parenchymal densities that are usually bilateral and rapidly progressive indicates a pneumonia. These are the most common complication within two months of transplantation. A combined alveolar and interstitial pattern in a perihilar distribution within two months of transplantation indicates pulmonary edema. A diffuse, bilateral reticulonodular pattern occurring more than two months following transplantation signifies the radiographic onset of interstitial lung disease. The development of diffuse, bilateral alveolar opacification extending to the periphery of the lung fields and associated with volume loss and air bronchograms indicates the adult respiratory distress syndrome. Etiologies are discussed.