{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:14:18Z","timestamp":1789017258238,"version":"build-2803163510"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T00:00:00Z","timestamp":1636329600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012524","name":"American Lebanese Syrian Associated Charities","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012524","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Pulmonary complications are common in children following hematopoietic cell transplantation (HCT) and contribute to their morbidity and mortality. Early diagnosis is essential for management and prevention of progression of lung injury and damage. In many cases, diagnosis can be challenging and may require diagnostic imaging and more invasive testing such as bronchoscopy and lung biopsy. We report the case of a 12-year-old girl who developed recurrent episodes of acute respiratory failure requiring intensive care unit admission in the post-HCT phase and describe the diagnostic and multidisciplinary approach for her management. In addition, we review the diagnostic approach of pulmonary complications post-HCT and highlight the utility and risks of bronchoscopy and lung biopsy in these children.<\/jats:p>","DOI":"10.3389\/fonc.2021.772411","type":"journal-article","created":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T06:56:27Z","timestamp":1636354587000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Pulmonary Complications in Children Following Hematopoietic Cell Transplantation: A Case Report and Review of the Diagnostic Approach"],"prefix":"10.3389","volume":"11","author":[{"given":"Lama","family":"Elbahlawan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"McArthur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cara E.","family":"Morin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafeez","family":"Abdelhafeez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Beth","family":"McCarville","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Ruiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saumini","family":"Srinivasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Qudeimat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2015.09.015","article-title":"A Critical Care and Transplantation-Based Approach to Acute Respiratory Failure After Hematopoietic Stem Cell Transplantation in Children","volume":"22","author":"Elbahlawan","year":"2016","journal-title":"Biol Blood Marrow Transplant"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1704426","article-title":"Incidence, Outcome, and Risk Factors of Late-Onset Noninfectious Pulmonary Complications After Unrelated Donor Stem Cell Transplantation","volume":"33","author":"Patriarca","year":"2004","journal-title":"Bone Marrow Transplant"},{"key":"B3","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.pcl.2020.09.003","article-title":"Pulmonary Manifestations of Hematologic and Oncologic Diseases in Children","volume":"68","author":"Elbahlawan","year":"2021","journal-title":"Pediatr Clin North Am"},{"key":"B4","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.bbmt.2004.09.008","article-title":"Natural History of Pulmonary Complications in Children After Bone Marrow Transplantation","volume":"11","author":"Eikenberry","year":"2005","journal-title":"Biol Blood Marrow Transplant"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0012.2010.01357.x","article-title":"Clinical Features of Late Onset Non-Infectious Pulmonary Complications Following Pediatric Allogeneic Hematopoietic Stem Cell Transplantation","volume":"25","author":"Park","year":"2011","journal-title":"Clin Transplant"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2014.151","article-title":"Pulmonary Complications in Hematopoietic SCT: A Prospective Study","volume":"49","author":"Lucena","year":"2014","journal-title":"Bone Marrow Transplant"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.05223","article-title":"Respiratory Care Considerations in the Childhood Cancer Patient","volume":"62","author":"Elbahlawan","year":"2017","journal-title":"Respir Care"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2017.207","article-title":"Hematopoietic Stem Cell Transplant-Associated Thrombotic Microangiopathy: Current Paradigm and Novel Therapies","volume":"53","author":"Khosla","year":"2018","journal-title":"Bone Marrow Transplant"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00026-2016","article-title":"Pulmonary Veno-Occlusive Disease","volume":"47","author":"Montani","year":"2016","journal-title":"Eur Respir J"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccm.2016.12.008","article-title":"Diagnostic Evaluation of Pulmonary Abnormalities in Patients With Hematologic Malignancies and Hematopoietic Cell Transplantation","volume":"38","author":"Harris","year":"2017","journal-title":"Clin Chest Med"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1378\/chest.99.4.928","article-title":"High-Resolution Ultrafast Chest CT in the Clinical Management of Febrile Bone Marrow Transplant Patients With Normal or Nonspecific Chest Roentgenograms","volume":"99","author":"Barloon","year":"1991","journal-title":"Chest"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.181.1.1887025","article-title":"Intrathoracic Complications Following Allogeneic Bone Marrow Transplantation: CT Findings","volume":"181","author":"Graham","year":"1991","journal-title":"Radiology"},{"key":"B13","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1200\/JCO.1999.17.3.796","article-title":"Pneumonia in Febrile Neutropenic Patients and in Bone Marrow and Blood Stem-Cell Transplant Recipients: Use of High-Resolution Computed Tomography","volume":"17","author":"Heussel","year":"1999","journal-title":"J Clin Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19970915)80:6<1160::AID-CNCR20>3.0.CO;2-5","article-title":"Routine Chest Radiography of Children With Cancer Hospitalized for Fever and Neutropenia: Is it Really Necessary","volume":"80","author":"Korones","year":"1997","journal-title":"Cancer"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.13934","article-title":"How to Manage Lung Infiltrates in Adults Suffering From Haematological Malignancies Outside Allogeneic Haematopoietic Stem Cell Transplantation","volume":"173","author":"Maschmeyer","year":"2016","journal-title":"Br J Haematol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-011-1366-7","article-title":"Diagnostic Value of Routine Chest Radiography in Febrile, Neutropenic Children for Early Detection of Pneumonia and Mould Infections","volume":"20","author":"Roberts","year":"2012","journal-title":"Support Care Cancer"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2004.06.009","article-title":"Pulmonary Infections in the Late Period After Allogeneic Bone Marrow Transplantation: Chest Radiography Versus Computed Tomography","volume":"53","author":"Schueller","year":"2005","journal-title":"Eur J Radiol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1148\/rg.343135080","article-title":"Noninfectious Pulmonary Complications After Hematopoietic Stem Cell Transplantation: Practical Approach to Imaging Diagnosis","volume":"34","author":"Pe\u00f1a","year":"2014","journal-title":"Radiographics"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.177.3.1770501","article-title":"High-Resolution CT of the Lungs","volume":"177","author":"Kazerooni","year":"2001","journal-title":"AJR Am J Roentgenol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2019180082","article-title":"Advanced CT Techniques for Decreasing Radiation Dose, Reducing Sedation Requirements, and Optimizing Image Quality in Children","volume":"39","author":"Gottumukkala","year":"2019","journal-title":"Radiographics"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.185.3.01850608","article-title":"Pulmonary Infections After Bone Marrow Transplantation: High-Resolution CT Findings in 111 Patients","volume":"185","author":"Escuissato","year":"2005","journal-title":"AJR Am J Roentgenol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.05.0439","article-title":"Thin-Section CT Findings in Hematopoietic Stem Cell Transplantation Recipients With Respiratory Virus Pneumonia","volume":"187","author":"Franquet","year":"2006","journal-title":"AJR Am J Roentgenol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"S79","DOI":"10.1093\/cid\/ciaa1855","article-title":"Guidance on Imaging for Invasive Pulmonary Aspergillosis and Mucormycosis: From the Imaging Working Group for the Revision and Update of the Consensus Definitions of Fungal Disease From the EORTC\/MSGERC","volume":"72","author":"Alexander","year":"2021","journal-title":"Clin Infect Dis"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium","volume":"71","author":"Donnelly","year":"2020","journal-title":"Clin Infect Dis"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/51409455","article-title":"Herpes Simplex Virus Pneumonia: High-Resolution CT Findings","volume":"83","author":"Chong","year":"2010","journal-title":"Br J Radiol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.11.7165","article-title":"CT Findings of Late-Onset Noninfectious Pulmonary Complications in Patients With Pathologically Proven Graft-Versus-Host Disease After Allogeneic Stem Cell Transplant","volume":"199","author":"Song","year":"2012","journal-title":"AJR Am J\u00a0Roentgenol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.184.2.01840629","article-title":"High-Resolution CT and Pathologic Findings of Noninfectious Pulmonary Complications After Hematopoietic Stem Cell Transplantation","volume":"184","author":"Franquet","year":"2005","journal-title":"AJR Am J Roentgenol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1159\/000029257","article-title":"High-Resolution Computed Tomography of Bronchiolitis Obliterans Syndrome After Bone Marrow Transplantation","volume":"65","author":"Ooi","year":"1998","journal-title":"Respiration"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1702773","article-title":"Yield of Bronchoalveolar Lavage in Ventilated and Non-Ventilated Children After Bone Marrow Transplantation","volume":"27","author":"Ben-Ari","year":"2001","journal-title":"Bone Marrow Transplant"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2007.00733.x","article-title":"Invasive Diagnostic Procedures for Pulmonary Infiltrates in Pediatric Hematopoietic Stem Cell Transplant Recipients","volume":"11","author":"Armenian","year":"2007","journal-title":"Pediatr Transplant"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2007.03.008","article-title":"Diagnostic Yield of Bronchoalveolar Lavage is Low in Allogeneic Hematopoietic Stem Cell Recipients Receiving Immunosuppressive Therapy or With Acute Graft-Versus-Host Disease: The St. Jude Experience, 1990-2002","volume":"13","author":"Kasow","year":"2007","journal-title":"Biol Blood Marrow Transplant"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.20784","article-title":"Fiberoptic Bronchoscopy and Bronchoalveolar Lavage for the Evaluation of Pulmonary Disease in Children With Primary Immunodeficiency and Cancer","volume":"48","author":"Efrati","year":"2007","journal-title":"Pediatr Blood Cancer"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2009.268","article-title":"The Clinical Importance of Bronchoalveolar Lavage in Allogeneic SCT Patients With Pneumonia","volume":"45","author":"Forsl\u00f6w","year":"2010","journal-title":"Bone Marrow Transplant"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2014.04.019","article-title":"A Comparison of Bronchoalveolar Lavage Versus Lung Biopsy in Pediatric Recipients After Stem Cell Transplantation","volume":"20","author":"Qualter","year":"2014","journal-title":"Biol Blood Marrow Transplant"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.23644","article-title":"Diagnostic Yield of Bronchoalveolar Lavage in Immunocompromised Children With Malignant and Non-Malignant Disorders","volume":"52","author":"Nadimpalli","year":"2017","journal-title":"Pediatr Pulmonol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13146","article-title":"Utility of Flexible Bronchoscopy With Polymerase Chain Reaction in the Diagnosis and Management of Pulmonary Infiltrates in Allogeneic HSCT Patients","volume":"32","author":"Tang","year":"2018","journal-title":"Clin Transplant"},{"key":"B37","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1111\/crj.13103","article-title":"The Value of Flexible Bronchoscopy in Pulmonary Infections of Immunosuppressed Children","volume":"14","author":"Eroglu-Ertugrul","year":"2020","journal-title":"Clin Respir J"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2009.203","article-title":"Utility of Early Versus Late Fiberoptic Bronchoscopy in the Evaluation of New Pulmonary Infiltrates Following Hematopoietic Stem Cell Transplantation","volume":"45","author":"Shannon","year":"2010","journal-title":"Bone Marrow Transplant"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.2147\/IDR.S235182","article-title":"Metagenomic Next-Generation Sequencing Versus Traditional Pathogen Detection in the Diagnosis of Peripheral Pulmonary Infectious Lesions","volume":"13","author":"Huang","year":"2020","journal-title":"Infect Drug Resist"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1053\/jpsu.2001.25799","article-title":"The Utility of Lung Biopsy in Recipients of Stem Cell Transplantation","volume":"36","author":"Dunn","year":"2001","journal-title":"J Pediatr Surg"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(88)80363-4","article-title":"The Usefulness of Open-Lung Biopsy in the Pediatric Bone Marrow Transplant Population","volume":"23","author":"Shorter","year":"1988","journal-title":"J Pediatr Surg"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1053\/jpsu.2002.30854","article-title":"Open Lung Biopsy in Pediatric Bone Marrow Transplant Patients","volume":"37","author":"Hayes-Jordan","year":"2002","journal-title":"J Pediatr Surg"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2004.03.002","article-title":"Diffuse Pulmonary Infiltrates After Bone Marrow Transplantation: The Role of Open Lung Biopsy","volume":"78","author":"Wang","year":"2004","journal-title":"Ann Thorac Surg"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1111\/petr.12060","article-title":"Severe Lung Injury and Lung Biopsy in Children Post-Hematopoietic Stem Cell Transplantation: The Differences Between Allogeneic and Autologous Transplantation","volume":"17","author":"Gassas","year":"2013","journal-title":"Pediatr Transplant"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2014.12.004","article-title":"Biopsy-Verified Bronchiolitis Obliterans and Other Noninfectious Lung Pathologies After Allogeneic Hematopoietic Stem Cell Transplantation","volume":"21","author":"Uhlving","year":"2015","journal-title":"Biol Blood Marrow Transplant"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2018.02.069","article-title":"Surgical Lung Biopsy in Children After Hematopoietic Cell Transplantation","volume":"53","author":"Ortega-Laureano","year":"2018","journal-title":"J Pediatr Surg"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2019.06.026","article-title":"Therapeutic Impact and Complications Associated With Surgical Lung Biopsy After Allogeneic Hematopoietic Stem Cell Transplantation in Children","volume":"25","author":"Dieffenbach","year":"2019","journal-title":"Biol Blood Marrow Transplant"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2019.07.016","article-title":"Percutaneous Lung Biopsy in Immunocompromised Pediatric Patients","volume":"31","author":"Cleveland","year":"2020","journal-title":"J Vasc Interv Radiol"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2017.238","article-title":"Transbronchial Biopsy in the Management of Pulmonary Complications of Hematopoietic Stem Cell Transplantation","volume":"53","author":"O\u2019Dwyer","year":"2018","journal-title":"Bone\u00a0Marrow Transplant"},{"key":"B50","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1097\/MPH.0000000000000644","article-title":"Safety and Benefits of Bronchoalveolar Lavage and Lung Biopsy in the Management of Pulmonary Infiltrates in Children With Leukemia","volume":"38","author":"Elbahlawan","year":"2016","journal-title":"J Pediatr Hematol Oncol"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.58.0480","article-title":"Bronchoalveolar Lavage and Lung Biopsy in Patients With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: A Systematic Review and Meta-Analysis","volume":"33","author":"Chellapandian","year":"2015","journal-title":"J Clin Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2021.772411\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T06:56:29Z","timestamp":1636354589000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2021.772411\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,8]]},"references-count":51,"alternative-id":["10.3389\/fonc.2021.772411"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2021.772411","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,8]]},"article-number":"772411"}}