A 57-year-old man underwent lung transplantation for severe emphysema 2 years ago. Over the last 6 months, he has had increasing exertional dyspnea and dry cough. The patient has adhered to his medical regimen. He does not smoke and has no exposure to secondhand smoke. Physical examination shows scattered bilateral rales and end-expiratory squeaks. Cardiac auscultation reveals no murmurs or additional sounds. Spirometry demonstrates markedly decreased FEV1 compared with findings 6 months prior, although the FVC remains largely unchanged. Chronic lung transplant rejection is suspected, and bronchoscopy with transbronchial biopsy is planned. Histopathology is most likely to show injury predominantly involving which of the following structures?

Question

A 57-year-old man underwent lung transplantation for severe emphysema 2 years ago.  Over the last 6 months, he has had increasing exertional dyspnea and dry cough.  The patient has adhered to his medical regimen.  He does not smoke and has no exposure to secondhand smoke.  Physical examination shows scattered bilateral rales and end-expiratory squeaks.  Cardiac auscultation reveals no murmurs or additional sounds.  Spirometry demonstrates markedly decreased FEV1 compared with findings 6 months prior, although the FVC remains largely unchanged.  Chronic lung transplant rejection is suspected, and bronchoscopy with transbronchial biopsy is planned.  Histopathology is most likely to show injury predominantly involving which of the following structures?

Quizplus · Accepted Answer

Eductional Objective: Chronic lung transplant rejection is due primarily to progressive scarring of the small airways, leading to bronchiolitis obliterans.  Manifestations occur months or years after transplantation and include obstructive lung disease (eg, reduced FEV1) with dyspnea and dry cough.

A 57-Year-Old Man Underwent Lung Transplantation for Severe Emphysema 2