E1302. Imaging of Abdominal Complications After Hematopoietic Stem Cell Transplant
  1. Lucas Cruz; Hospital Beneficência Portuguesa de São Paulo
  2. Fernanda Gonçalves; Hospital Beneficência Portuguesa de São Paulo
  3. Marília Ferreira; Hospital Beneficência Portuguesa de São Paulo
  4. Marcela Leite; Hospital Beneficência Portuguesa de São Paulo
  5. Maria Helena Pedroso; Hospital Beneficência Portuguesa de São Paulo
  6. Ítalo Cruz; Hospital Beneficência Portuguesa de São Paulo
  7. Carolina Abud; Hospital Beneficência Portuguesa de São Paulo
Thousands of bone marrow transplants (BMT) are performed each year worldwide as treatment for malignant and non-malignant diseases. The majority of the patients will present some sort of abdominal complication sometime after the procedure. Knowing these complications based on time after the BMT and its imaging findings is crucial for the radiologist.

Educational Goals / Teaching Points
The goals of this presentation are that, by the end of it, the participant should understand the basic immunological and biological processes involved in Hematopoietic Stem Cell Transplant (HSCT), and comprehend the abdominal complications pathophysiology after HSCT as well. And finally, to identify and discuss the imaging findings of abdominal complications based on time after transplantation.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Abdominal complications after HSCT affect more than 80% of the patients, with hepatobiliary complications being the most common. The major causes of hepatic dysfunction are veno-occlusive disease (VOD) and acute graft-versus-host disease (GVHD). Both can exhibit periportal and gallbladder wall edema, but the presence of heterogeneous liver parenchyma and narrowed hepatic veins, as well as variations in the flows of the Doppler US are more suggestive of VOD. Liver infections can also be seen, with fungal abscesses, while viral hepatitis manifests with cholestasis. Acute GVHD, pseudomembranous colitis, neutropenic colitis and infectious enterocolitis presents with bowel wall thickening, mucosal enhancement, bowel dilatation, mesenteric fat stranding and ingurgitated vessels. About the renal and urinary tract complications, in patients with hemorrhagic cystitis there are bladder wall thickening, irregular and sloughed mucosa, and intraluminal clots. Meanwhile, renal abscesses and pyelonephritis show one or more wedge-shaped areas of lesser enhancement extending from the papilla to the renal cortex, that can progress to abscesses.

HSCT is one of the key treatments for patients with hematologic diseases, however, it can present complications that often overlap its image aspects, therefore the knowledge of the pathophysiologic mechanisms that are triggered before and after engraftment is essential to make a firm diagnosis.