Pulmonary infection after cardiac transplantation: clinical and radiologic correlations.

Forty-one episodes of radiographically demonstrated pulmonary infection developed in 35 (30%) of 118 cardiac transplant recipients treated with cyclosporine. The most common pathogens were cytomegalovirus (CMV) (13 episodes), Pneumocystis carinii (12 episodes), and Aspergillus (five episodes). Appearance of CMV infection on radiographs was generalized and hazy (n = 9) or limited to one lobe (n = 4). All episodes of P carinii pneumonia, including six combined with CMV infection, appeared diffusely hazy. Aspergillus infection appeared either shaggy and nodular (n = 3) or bibasilar and hazy (n = 2). Aspergillus infection developed only early after transplantation (0.2-2.5 months), whereas CMV infection (1.1-6.1 months) and P carinii pneumonia (2.6-10.3 months) developed later (time ranges for latter two infections exclude three episodes that developed even later in two patients at risk for acquired immunodeficiency syndrome). Nine (8%) patients died of pulmonary infection, eight (7%) within 4.0 months of transplantation. Symptoms or signs were variable; none were found in four (10%) of 41 episodes. The authors recommend frequent chest radiographs in the early months after transplantation.