Imaging description

A 14-year-old female with a prior history of double lung transplantation for end-stage cystic fibrosis presented with abdominal pain, constipation, and fever. A non-contrast CT scan (not shown) demonstrated nodular gastric wall thickening, intra-abdominal lymphadenopathy, and bilateral lung nodules. These findings were concerning for post-transplantation lymphoproliferative disorder (PTLD). A subsequent staging 18F-FDG PET/CT showed intense 18F-FDG uptake within the lesions noted on the non-contrast CT and also identified additional 18F-FDG-avid sites of disease within the bowel and the left kidney that were not apparent on the corresponding or previous non-contrast CT images (Fig. 54.1). The diagnosis of Epstein–Barr virus (EBV)-positive PTLD was confirmed by biopsy. Serial 18F-FDG PET/CT studies were then performed to monitor the disease, which initially demonstrated complete response to treatment, only to be followed by subsequent recurrence within the liver (Fig. 54.2).

Importance

PTLD is a rare but serious complication of chronic immunosuppression occurring in the setting of either solid organ or bone marrow transplantation. PTLD represents a spectrum of lymphoproliferative disorders, ranging from abnormal lymphoid hyperplasia to frank malignant lymphoma. PTLD is the most common post-transplant neoplasm in children.