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Solitary pulmonary nodule in the liver transplant candidate: Importance of diagnosis and treatment
Author(s) -
Concejero Allan M.,
Yong CheeChien,
Chen ChaoLong,
Lu HungI,
Wang ChihChi,
Wang ShihHo,
Liu YuehWei,
Yang ChinHsiang,
Cheng YuFan,
Jawan Bruno
Publication year - 2010
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.22066
Subject(s) - medicine , liver transplantation , nodule (geology) , intensive care medicine , radiology , transplantation , paleontology , biology
Our objectives were to define the incidence and etiology of solitary pulmonary nodules (SPNs) in patients undergoing living donor liver transplantation (LDLT), describe a diagnostic approach to the management of SPNs in LDLT, and define the impact of SPNs on the overall survival of adult LDLT recipients. Nine patients (9/152, 5.9%) were diagnosed with an SPN on the basis of chest radiography findings during the pretransplant survey. All were male. The mean age was 52 years. All the patients had hepatitis B virus–related cirrhosis with hepatocellular carcinoma. All were asymptomatic for the lung lesion. All underwent contrast‐enhanced chest computed tomography (CT) to verify the presence and possible etiology of the SPNs. In 3 cases, CT was used to definitely determine that there was no pulmonary nodule; in 2, CT led to a definite diagnosis of pulmonary tuberculosis. In 4, CT led to a definite identification of an SPN but not to an etiological diagnosis. Two patients underwent outright thoracoscopy and biopsy of their SPNs. Biopsy showed cryptococcosis in both patients. One received a therapeutic trial of an antituberculosis treatment, and repeat CT after 1 month showed a regression in the size of the SPN. A diagnosis of tuberculosis was made. One patient had an inconclusive whole body positron emission tomography scan and subsequently underwent thoracoscopy where biopsy showed tuberculosis. A concomitant malignancy, either primary lung cancer or metastasis from the liver tumor, was not identified. All patients were surviving with their original grafts and were lung infection–free. The overall mean posttransplant follow‐up was 54 months (range = 33‐96 months). Liver Transpl 16:760‐766, 2010. © 2010 AASLD.