case_images: PMC11802471_01
case_images: PMC11802471_02
case_images: Melanoptysis aspirate collected during bronchoscopy. The image shows a plastic container with dark, sand-like material aspirated from the native lung of the transplant recipient during the bronchoscopy procedure. This material is consistent with melanoptysis, a rare complication observed in patients with pneumoconiosis.
case_images: ivaf004f1.jpg
case_images: PMC11802471_02_ivaf004f1.jpg
case_images: ivaf004-F1
case_images: During the bronchoscopy procedure, bronchoalveolar lavage of both the native and transplanted lung was performed using 60 ml of saline solution per lung, and after the procedure, from the native lung, a persistent outflow of dark, sand-like content was observed and aspirated (Fig. 1).
case_images: PMC11802471_03
case_images: Chest radiographs before and after bronchoscopy. Left: pre-bronchoscopy chest X-ray showing the patient's post-transplant status with a left single-lung transplant. Right: post-bronchoscopy chest X-ray taken 1 h after the procedure, revealing extensive acute inflammatory involvement in the transplanted left lung, characterized by new diffuse opacities.
case_images: ivaf004f2.jpg
case_images: PMC11802471_03_ivaf004f2.jpg
case_images: ivaf004-F2
case_images: A same-day follow-up chest imaging study 1 h after the bronchoscopy revealed extensive acute inflammatory involvement in the transplanted lung (Fig. 2).
case_images: Timeline of critical events in the post-transplant period. The figure illustrates the key clinical events and interventions from Days 1 through 8 post-transplantation.
case_images: ivaf004f3.jpg
case_images: PMC11802471_03_ivaf004f3.jpg
case_images: ivaf004-F3
case_images: Given this development, the medical team decided to intubate the patient and initiate prone positioning therapy for 48 h, the timeline is shown in Fig. 3.