A 55-year-old male with a history of allogeneic bone marrow transplantation presents with progressive dyspnea and cough. HRCT shows air trapping on expiratory scans, mosaic attenuation, and bronchiectasis without significant ground-glass opacity. Which of the following is the most likely diagnosis?
- A Acute graft-versus-host disease of the lung
- B Bronchiolitis obliterans syndrome ✓
- C Cryptogenic organizing pneumonia
- D Cytomegalovirus pneumonia
Correct answer: B. Bronchiolitis obliterans syndrome
Explanation
Bronchiolitis obliterans syndrome (BOS) is a form of chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. It manifests as airflow obstruction with air trapping, mosaic attenuation, and bronchiectasis on expiratory HRCT. Acute GVHD does not primarily affect the lungs. Cryptogenic organizing pneumonia shows peripheral consolidations. CMV pneumonia shows ground-glass opacities and nodules.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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