Flat Chest of Pleuroparenchymal Fibroelastosis Reversed by Lung Transplantation Masahiro Yanagiya, MD, Masaaki Sato, MD, PhD, Shun Kawashima, MD, Hideki.

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Flat Chest of Pleuroparenchymal Fibroelastosis Reversed by Lung Transplantation Masahiro Yanagiya, MD, Masaaki Sato, MD, PhD, Shun Kawashima, MD, Hideki Kuwano, MD, PhD, Kazuhiro Nagayama, MD, PhD, Jun-ichi Nitadori, MD, PhD, Masaki Anraku, MD, PhD, Jun Nakajima, MD, PhD The Annals of Thoracic Surgery Volume 102, Issue 4, Pages e347-e349 (October 2016) DOI: 10.1016/j.athoracsur.2016.02.092 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Series of chest roentgenograms with diagnosis, before transplantation, and after transplantation. (A) Patient at 27 years old with diagnosis of PPFE. (B) Patient at 28 years old before lung transplantation. (C) Lateral chest roentgenogram showing flattening of the chest. (D) Patient at 6 months after lung transplantation. (PPFE = pleuroparenchymal fibroelastosis.) The Annals of Thoracic Surgery 2016 102, e347-e349DOI: (10.1016/j.athoracsur.2016.02.092) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Flattening and reversal of the patient’s thoracic cage over time. (A) Computed tomographic (CT) scan of the chest when patient was 26 years old and she had no specific signs or symptoms of PPFE. The anteroposterior diameter (right: a) to the transverse diameter (t) of her hemithorax was measured at the level of the sixth vertebra. (B) Chest CT at age 28 years with diagnosis of PPFE before lung transplantation. (C) Chest CT 6 months after lung transplantation. (D) The flatness of the thoracic cage of each hemithorax, represented by the anteroposterior diameter/transverse diameter ratio, was decreased by the time of transplantation and was then increased after lung transplantation. (PPFE = pleuroparenchymal fibroelastosis.) The Annals of Thoracic Surgery 2016 102, e347-e349DOI: (10.1016/j.athoracsur.2016.02.092) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Size matching using three-dimensional computed tomographic (CT) volumetry of donors and recipient. Although the calculated graft vital capacity was limited to approximately 50% of the calculated recipient’s vital capacity, these grafts appeared to fit well in the shrunken thoracic cage of the patient. The CT images were taken at the inspiratory phase in both donors and the recipient. These three-dimensional images are shown with the same scale. The Annals of Thoracic Surgery 2016 102, e347-e349DOI: (10.1016/j.athoracsur.2016.02.092) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions