case_images: PMC9112311_01
case_images: Date: 11-2018: Transverse (left) and coronal (right) views of chest computed
  tomographic (CT) scan showing scattered ground glass opacities (GGO) in the
  lung bases bilaterally and mild diffuse bronchiectasis in all lobes, as
  first radiological changes after both hematopoietic stem cell
  transplants.
case_images: 10.1177_11795476221097317-fig1.jpg
case_images: PMC9112311_01_10.1177_11795476221097317-fig1.jpg
case_images: fig1-11795476221097317
case_images: In November 2018, he presented to the clinic for dyspnea and nonproductive cough, for which a computed tomographic (CT) scan of the chest was done and showed scattered ground glass opacities (GGO) in the lung bases bilaterally and mild diffuse bronchiectasis in all lobes (Figure 1). His pulmonary function test (PFT) also showed further significant drop in his FEV1, and to a greater extent, his FVC (Figure 1).
case_images: Date 03-2019: Follow-up chest computed tomographic (CT) scan showing (Left:
  Transverse view; Right: Coronal view) progression of the bilateral lower to
  mid lobe predominant, peripheral and peribronchovascular consolidations with
  worsening traction bronchiectasis and evidence of a new architectural
  distortion. These changes were previously visualized, only 4 months earlier,
  as scattered ground glass abnormalities with a milder form of diffuse
  traction, as shown in Figure 1.
case_images: 10.1177_11795476221097317-fig2.jpg
case_images: PMC9112311_01_10.1177_11795476221097317-fig2.jpg
case_images: fig2-11795476221097317
case_images: A repeat CT scan of the chest showed development of new lower lobe predominant bilateral, peripheral, peribronchovascular consolidations in the areas of previously seen GGOs, with worsening traction bronchiectasis and evidence of a new architectural distortion (Figure 2), and a suspicion of organizing pneumonia was raised in the radiology report, with a suggestion of chronic pulmonary GVHD, and less likely infection or medication side effect.
case_images: Date 05-2019: Follow-up chest computed tomographic (CT) scan, transverse
  view, showing the appearance of the first pulmonary cystic changes (white
  arrows) in bilateral upper lobes, with associated mild traction
  bronchiectasis (black arrowheads) suggestive of a fibrosing and progressive
  pulmonary pathology.
case_images: 10.1177_11795476221097317-fig3.jpg
case_images: PMC9112311_01_10.1177_11795476221097317-fig3.jpg
case_images: fig3-11795476221097317
case_images: A new CT scan of the chest showed further worsening in bilateral, mid-lung predominant consolidations and ground glass opacities, with changes of traction bronchiectasis and appearance of new cystic changes (Figure 3).
case_images: Date: 08-2020: Transverse (Left) and Coronal (Right) of chest computed
  tomographic (CT) scan, done 14 months after the second transplant, and
  showing severe upper and mid-lung zones predominant bronchiectatic changes
  in peri-bronchovascular and peripheral distribution, along with bilateral
  and extensive upper lobe predominant cysts. The significant decrease in
  ground glass opacities visualized on previous imaging is indicative of the
  decrease in inflammatory component of the patient's progressive lung
  damage.
case_images: 10.1177_11795476221097317-fig4.jpg
case_images: PMC9112311_01_10.1177_11795476221097317-fig4.jpg
case_images: fig4-11795476221097317
case_images: Subsequent pulmonary imaging over the following year showed a steady progression of his consolidations and traction bronchiectasis, significant decrease in ground-glass abnormalities throughout both lungs, a decrease in FDG uptake indicative of decrease in the inflammatory process and formation of scar tissue with a remarkable spatial shift to the mid and upper lung zones and progressive appearance of new cystic lesions in the upper lobes bilaterally (Figure 4).