Cerebral Tissue Pulmonary Embolism Masquerading as Primary Graft Dysfunction After Lung Transplantation.

Early graft dysfunction following lung transplantation is commonly attributed to primary graft dysfunction (PGD). However, other rare etiologies may present with similar clinical and radiologic features. We report a unique case of a 58-year-old male with idiopathic pulmonary fibrosis who underwent bilateral lung transplantation. The donor was a young adult with traumatic brain injury. Within hours post-transplant, the recipient developed severe hypoxemia and diffuse infiltrates on chest imaging, consistent with Grade 3 PGD. Despite supportive therapy, there was limited improvement. Histopathological examination of transbronchial biopsies revealed cerebral cortical neurons and glial tissue embedded in the pulmonary vasculature, confirming cerebral tissue embolism. This case highlights cerebral tissue pulmonary embolism as an under-recognized cause of early allograft dysfunction. Clinicians should consider donor-derived embolic events, particularly in trauma-related donors, in the differential diagnosis of PGD-like presentations.