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Thoracic Air Leak Syndrome

- Clinical:

Thoracic air leak syndrome (TALS) is a late-onset pulmonary complication of allogeneic hematopoietic stem cell transplantation (HSCT) with an incidence of 0.83-2.1% [1]. The median time from transplantation to the diagnosis of TALS is approximately 1 year, but may develop as early as 2 months following transplantation [1].

The condition refers to the spontaneous leakage of air from normal air-containing structures in a lung that is affected by other complications of HSCT [1]. The first spaces in which the leaked air usually accumulates are the places that are immediately close to the alveoli- including the pulmonary interstitial tissue, mediatinum, and pleural space [1]. From there, the air may propogate further to more distant structures, such as the pericardium, spinal canal, muscles, and subcutaneous tissues [1]. Any spontaneous pulmonary interstitial emphysema, pneumomediastinum, pneumothorax, pneumopericardium, pneumorrhachis, soft tissue, and subcutaneous air in an allogeneic HSCT patient is considered to be TALS, after other etiologies have been excluded [1].

TALS is commonly associated with bronchiolitis obliterans (BO) [1]. It is postulated that narrowing of the small airways in the process of BO, impedes the backflow of air from alveoli to upper airways during expiration [1]. This results in air being trapped in the alveoli and intra-alveolar pressure rises [1]. The alveolar wall is disrupted and gas extrudes from the alveoli into the adjacent tissues [1].

- X-ray:

In addition to areas of air leak, findings of BO are present in the lungs including expiratory air trapping, bronchiectasis, bronchial wall thickening, and centrilobular nodules [1].

REFERENCES:

(1) Radiology 2020; Khoshbin AP, Aliannejad R. Case 281: Thoracic air leak syndrome in a patient with hematopoietic stem cell transplantation and graft-versus-host disease. 296: 710-712
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