Review ArticlesImaging Evaluation of Lung Transplantation Patients A Time and Etiology-based Approach to High-resolution Computed Tomography InterpretationAmadi, Chiemezie C. MD, MA*; Galizia, Mauricio S. MD*; Mortani Barbosa, Eduardo J. Jr MD†Author Information *Wexner Medical Center, Ohio State University †Hospital of the University of Pennsylvania, Philadelphia, PA The authors declare no conflicts of interest. Correspondence to: Chiemezie C. Amadi, MD, MA, Department of Radiology, Ohio State University, 395 W. 12th Avenue, 4th Floor, Columbus, OH 43210 (e-mail: [email protected]). Journal of Thoracic Imaging: September 2019 - Volume 34 - Issue 5 - p 299-312 doi: 10.1097/RTI.0000000000000419 Buy Metrics Abstract Lung transplantation is an established therapeutic option for patients with irreversible end-stage pulmonary disease limiting life expectancy and quality of life. Common indications for lung transplantation include chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, cystic fibrosis, pulmonary arterial hypertension, and alpha-1 antitrypsin deficiency. Complications of lung transplantation can be broadly divided etiologically into surgical, infectious, immunologic, or neoplastic. Moreover, specific complications often occur within a certain time interval following surgery, which can be broadly classified as early (<6 wk), intermediate (6 wk to 6 mo), and late (>6 mo). Thus, each group of complications can further be categorized on the basis of the time continuum from transplantation. Imaging, primarily by high-resolution computed tomography, plays a critical role in early diagnosis of complications after lung transplantation. Early recognition of complications by the radiologist, and initiation of therapy, contributes to improved morbidity and mortality. However, accurate diagnosis is only feasible if one has a thorough understanding of the major etiologic categories of complications and how they relate to the time course since transplantation. We review imaging manifestations of lung transplant complications via a framework that includes the following major etiologic categories: surgical; infectious; immunologic; and neoplastic; and the following time frames: surgery to 6 weeks; 6 weeks to 6 months; and beyond 6 months. We propose this approach as a logical, evidence-based algorithm to construct a narrow, optimal differential diagnosis of lung transplantation complications. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.