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Bronchiolitis obliterans syndrome — SCE Respiratory MCQ

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HardTransplantationBronchiolitis obliterans syndromeSCE Respiratory

A 58-year-old bilateral lung transplant recipient develops progressive exertional dyspnoea 18 months after transplant. Spirometry shows FEV1 has fallen by 24% from baseline with an obstructive pattern; CT shows air trapping and no acute infection is found on BAL. What is the most likely diagnosis?

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Correct answer: C — Bronchiolitis obliterans syndrome from chronic lung allograft dysfunction

The best answer is “Bronchiolitis obliterans syndrome from chronic lung allograft dysfunction”. The clinical pattern, physiology and imaging described are most consistent with Bronchiolitis obliterans syndrome from chronic lung allograft dysfunction. The competing diagnoses may share individual findings, but do not account for the complete combination in the stem. The remaining choices—“Obesity hypoventilation syndrome, after safety review, after safety review”, “Uncomplicated asthma diagnosed for the first time, after specialist assessment”, “Primary spontaneous pneumothorax, within a respiratory pathway”, “Acute pulmonary embolism, after safety review, within a respiratory pathway”—are credible in related respiratory presentations, but each addresses a different diagnostic, staging or management decision and does not fit the decisive findings and pathway position in this stem.

Reference: ISHLT consensus on chronic lung allograft dysfunction: https://www.jhltonline.org/article/S1053-2498(19)31425-1/fulltext