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Original articles
Evaluation of pneumatosis intestinalis as a complication of lung transplantation
Valoración de la neumatosis intestinal como complicación del trasplante pulmonar
V. Belloch Ripollésa,
Corresponding author
vicentebelloch94@gmail.com

Corresponding author.
, C.F. Muñoz Núñeza, A. Fontana Bellorínb, A. Batista Doménecha, A. Boukhoubzaa, M. Parra Hernándeza, L. Martí-Bonmatía
a Servicio de Radiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
b Unidad de Trasplante Pulmonar, Servicio de Cirugía Torácica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Pneumatosis intestinalis is a radiological finding characterised by the presence of gas in the wall of the small or large intestine&#46; It is associated with multiple entities&#44; ranging from benign to life-threatening conditions such as ischaemia&#44; intestinal obstruction and necrotising enterocolitis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Benign pneumatosis intestinalis is a rare finding&#44; detected incidentally in imaging tests&#44; usually in immunosuppressed patients with solid organ transplantation&#44; graft-versus-host disease&#44; asthma or COPD or as an endoscopy complication&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Its occurrence in adult lung transplant patients has been reported as a benign and conservatively managed entity both in isolated cases<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;12</span></a> and in short series&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;15</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Our objective is to describe the incidence of this complication in lung transplant patients&#44; describe its associations and assess its clinical relevance&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">A total of 546 adult lung transplants were performed at our university hospital between January 2011 and October 2022 &#40;141 months&#41;&#46; The patients were selected by a search &#40;pneumatosis intestinalis or pneumatosis coli or pneumatosis&#41; in the hospital&#8217;s Lung Transplant Unit database&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In all patients&#44; the presence of pneumatosis intestinalis &#40;considered as the episode&#41; after transplantation was confirmed in their clinical history&#44; and the following relevant variables were gathered to evaluate association and clinical expression&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0025" class="elsevierStylePara elsevierViewall">Demographic variables&#58; age&#44; sex&#44; indication and type of transplant &#40;single-lung&#44; double-lung or heart-lung&#41;&#44; post-surgical complications &#40;yes&#47;no and which&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8211;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Time from transplant to the episode &#40;days&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8211;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical data at the time of the episode&#58; abdominal signs and symptoms&#44; vital signs &#40;blood pressure&#44; heart rate&#44; O<span class="elsevierStyleInf">2</span> saturation and temperature&#41;&#44; signs of rejection &#40;yes&#47;no and which&#41;&#44; evidence of pulmonary or gastrointestinal infection&#44; blood tests &#40;white blood cell count&#44; CRP&#44; lactate&#44; bicarbonate&#44; amylase pH&#41;&#44; immunosuppressive medication &#40;type and dose&#41; and whether the patient was hospitalised&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8211;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Imaging data&#58; indication for the test&#44; imaging technique used to diagnose pneumatosis&#44; radiological findings &#40;presence and distribution of air&#41;&#44; pneumoperitoneum&#44; portal or mesenteric venous pneumatosis&#44; free fluid&#44; pneumobilia&#44; indication for other imaging tests&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8211;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Therapeutic approach&#58; medical treatment&#44; surgical treatment&#44; time to resolution of pneumatosis&#46;</p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">The study was approved by the Research Ethics Committee of the Hospital Universitario y Polit&#233;cnico La Fe &#40;registration number&#58; 2022-925-1&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">Of the 546 lung transplant patients&#44; 17 &#40;3&#46;1&#37;&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; with pneumatosis intestinalis were identified&#46; The main clinical and radiological data are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Of the 17 patients included&#44; 12 were male and 5 female&#44; with a mean age of 51 years &#40;range 21&#8211;66 years&#41;&#46; The indications for transplantation were pulmonary fibrosis &#40;6 cases&#41;&#44; emphysema &#40;4 cases&#41;&#44; cystic fibrosis &#40;3 cases&#41;&#44; congenital heart disease with pulmonary hypertension &#40;2 cases&#41;&#44; primary ciliary dyskinesia &#40;1 case&#41; and pneumoconiosis &#40;1 case&#41;&#46; Transplantation was either single-lung &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;4&#41;&#44; double-lung &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;11&#41; or heart-double lung &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;2&#41;&#46; Some type of post-surgical complication was observed in 11 patients with pneumatosis &#40;65&#37;&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The mean time from transplantation to diagnosis was 198 days and the median was 68 days&#44; ranging from 9 to 1270 days&#46; When pneumatosis was diagnosed&#44; 16 patients &#40;94&#37;&#41; were asymptomatic or had mild abdominal discomfort &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;2&#41;&#44; bloating &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;3&#41;&#44; nausea&#47;vomiting &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;2&#41; or diarrhoea &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;1&#41;&#46; In this group&#44; the physical examination was normal&#46; Only 6 patients had leukocytosis with neutrophilia and elevated CRP &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The symptomatic patient &#40;no&#46;&#160;14&#160;in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; was diagnosed with <span class="elsevierStyleItalic">Clostridium difficile &#40;C&#46; difficile&#41;</span> colitis&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">At the time of the episode&#44; 8 patients had clinical or pathological signs of rejection &#40;47&#37;&#41; and 4 had signs of pulmonary &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;2&#41; or gastrointestinal &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;2&#41; infection&#46; Eleven patients were inpatients &#40;65&#37;&#41; and 6 were outpatients&#46; All patients were on immunosuppressive treatment &#40;corticosteroids&#44; calcineurin inhibitors and antiproliferative agents&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In 76&#37; of the cases &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;13&#41; pneumatosis was identified on the chest X-ray or CT scan&#44; whose most frequent indication was to assess lung transplantation status &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The remaining cases were diagnosed by an abdomino-pelvic CT scan&#46; Pneumatosis was most frequently observed in the ascending colon&#44; hepatic flexure and transverse colon&#46; The pneumatosis involved the caecum &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;5&#41;&#44; ascending colon &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;10&#41;&#44; hepatic flexure &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;10&#41;&#44; transverse colon &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;7&#41;&#44; splenic flexure &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;3&#41;&#44; descending colon &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;2&#41;&#44; sigmoid colon &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;1&#41;&#44; rectum &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;1&#41;&#44; terminal ileum &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;1&#41; and gastric fundus &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;1&#41;&#46; However&#44; only 10 patients &#40;59&#37;&#41; had an abdomino-pelvic CT scan to assess the distribution of pneumatosis throughout the bowel &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The patient with gastric pneumatosis &#40;no&#46;&#160;16&#41; also had a bilateral pneumothorax&#44; multiple small breaks in continuity in the chest wall&#44; both in the thoracotomy and sternotomy sutures&#44; subcutaneous emphysema&#44; and was diagnosed with air leak with thoracotomy dehiscence as a post-surgical complication&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The findings associated with pneumatosis observed were pneumoperitoneum in 12 patients &#40;70&#37;&#41;&#44; free fluid in 2 cases &#40;12&#37;&#41; and portal venous pneumatosis in 1 case &#40;6&#37;&#41;&#46; No mesenteric venous pneumatosis or pneumobilia was identified in any case&#46; One of the patients with free fluid &#40;no&#46;&#160;14&#41;&#160;was diagnosed with <span class="elsevierStyleItalic">Clostridium</span> colitis&#46; Finally&#44; 10 interconsultations were made to the Digestive Medicine &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;6&#41; and Digestive Surgery &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;4&#41; departments for the evaluation of 9 patients&#44; 8 of whom were asymptomatic&#46; Forty-six per cent &#40;46&#37;&#41; of the patients diagnosed by chest radiography or CT scan &#40;6&#47;13&#41; had an abdomino-pelvic CT scan to complete the study&#46; Treatment was expectant management in all the cases of asymptomatic pneumatosis intestinalis&#46; The patient with colitis &#40;no&#46;&#160;14&#41; was treated with antibiotics and the patient with gastric pneumatosis and air leak &#40;no&#46;&#160;16&#41; underwent surgery&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The mean time to resolution was 389 days &#40;median 145 days&#44; range 72&#8211;1591 days&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">The incidence of post-lung transplantation pneumatosis intestinalis in our hospital was 3&#46;1&#37;&#44; occurring between 9 and 1270 days post-transplantation&#46; Patients were asymptomatic or with mild symptoms&#44; with no major laboratory abnormalities&#46; The radiological appearance was cystic&#47;expansive&#46; Treatment was conservative in all asymptomatic cases&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Of the 55 published cases of pneumatosis intestinalis in lung transplant patients&#44; 15 were clinical cases<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;12</span></a> and 40 in series of 7&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> 10<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and 23<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> patients&#46; The incidence published by Thompson et al&#46; &#40;2&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Chandola et al&#46; &#40;2&#46;68&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and Christiansen et al&#46; &#40;5&#46;2&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> is similar to our own&#46; Since it is often an incidental finding&#44; the true incidence is probably being underestimated&#46; The time from transplantation to onset in the series of Thompson et al&#46; &#40;median 105 days&#44; range 18&#8211;453 days&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Chandola et al&#46; &#40;median 82 days&#44; range 5&#8211;2495 days&#41;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and Christiansen et al&#46; &#40;median 47 days&#44; range 5&#8211;1477 days&#41;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> is similar to our own &#40;median 68 days&#44; range 9&#8211;1270 days&#41;&#46; Although this is a complication that may occur over a long period of time&#44; it is eminently late&#44; usually appearing 6 months after the transplantation&#46; As in the previous series&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;15</span></a> most patients were asymptomatic or had mild abdominal symptoms&#44; with no major abnormalities on physical examination or in the laboratory tests&#46; Patients who were truly symptomatic or had other associated disorders had alternative diagnoses to benign pneumatosis intestinalis&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Benign pneumatosis intestinalis in transplantees often has a cystic and expansive appearance &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; with a large amount of air in the intestinal wall&#46; It is useful to evaluate it with the lung window to ascertain the extent &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; In contrast&#44; pneumatosis intestinalis due to intestinal ischaemia or occlusion predominantly affects the small bowel&#44; and the gas bubbles usually present a finer and more linear arrangement in the wall<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and are accompanied by other warning signs such as wall thickening or thinning&#44; absence of mural enhancement&#44; dilatation of the intestinal loops&#44; free fluid and inflammatory changes in the adjacent mesentery &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; This expansive aspect of pneumatosis and the absence of other radiological findings support a benign aetiology and clinical course&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">In our series&#44; pneumatosis intestinalis was associated with pneumoperitoneum&#44; portomesenteric gas and free fluid&#46; Seventy percent of the patients in our series had associated pneumoperitoneum dissecting mesenteric fatty planes&#46; Only one of these patients underwent surgery for an air leak with dehiscence of the sternothoracotomy &#40;no&#46; 16&#41;&#46; Portal venous gas has been linked to an increased risk of requiring surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In our series&#44; the only diagnosed case of <span class="elsevierStyleItalic">C&#46; difficile</span> pancolitis was associated with free fluid and colon wall thickening&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The pathophysiology of pneumatosis intestinalis in transplant recipients remains unclear&#46; Three causal mechanisms have been proposed&#58; mechanical&#44; bacteriological and biochemical&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The mechanical theory<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> suggests that gas dissects into the intestinal wall from the intestinal lumen or the mediastinum due to increased intraluminal or mediastinal pressure&#44; as occurs in mechanically ventilated patients<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> with asthma or COPD&#46; In our series&#44; there were no patients on mechanical ventilation during the episode&#46; On the other hand&#44; gas-producing bacteria enter the submucosa through defects in the mucosa and produce gas in the intestinal wall&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Some publications have attributed pneumatosis intestinalis to CMV<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> or <span class="elsevierStyleItalic">C&#46; difficile</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> infections&#44; which are common in the context of immunosuppression and are inevitably associated with transplantation&#46; In our series&#44; no patient presented active CMV infection and only one patient presented <span class="elsevierStyleItalic">Clostridium</span> colitis&#44; whose clinical-radiological appearance was different from the asymptomatic cases&#46; The biochemical theory<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> postulates that excessive fermentation of carbohydrates in the intestinal lumen by bacteria produces gas&#44; which is absorbed by the intestinal wall&#46; The cystic presentation of pneumatosis in transplant patients is not conducive to this being the causative mechanism&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The association of pneumatosis with atrophy of lymphoid tissues in the intestinal wall due to immunosuppression related to the intake of immunosuppressants and corticosteroids in transplant recipients has been described&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> This atrophy compromises mucosal integrity and allows gas to enter the intestinal wall&#46; The use of immunosuppressants and corticosteroids is an antecedent that is present in all patients in the published series<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;15</span></a> and in our own&#44; hence it would be reasonable for it to have a relevant role in the pathophysiology of post-transplant pneumatosis&#44; probably propitiating the mechanism described by the mechanical theory&#46; Christiansen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> relate the development of pneumatosis to the placement of gastrojejunostomy tubes&#46; In our series&#44; post-transplantation nutrition was mainly oral&#44; or parenteral when the latter was not possible&#59; only one case &#40;no&#46;&#160;6&#41; had a gastrostomy at the time of the diagnosis of pneumatosis&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Although further complementary tests and consultations are often requested&#44; the therapeutic decision was conservative in all cases&#46; There are cases described in the literature<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;13&#44;15</span></a> of exploratory laparotomies due to radiological findings&#44; despite the absence of symptoms and a normal physical examination and blood tests&#46; In the series of Christiansen et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> these patients are treated with supplemental oxygen&#44; bowel rest and antibiotics&#44; without altering the immunosuppressive regimen&#46; In the majority of cases in our hospital&#44; a watchful waiting attitude was maintained&#44; without any therapeutic modification&#44; and only in two cases was domperidone prescribed as a prokinetic &#40;numbers&#160;2&#160;and 12&#41;&#44; with a good clinical evolution in all cases and an average time to resolution of 389 days&#46; Medical treatment should be symptomatic&#44; and the addition of antimicrobial treatment is debatable in the absence of infectious symptoms&#46; Finally&#44; verifying resolution does not seem to be necessary&#44; since it may take time to disappear or it may present a relapsing-remitting evolution&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in most cases following a benign clinical course with conservative management&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Some of this study&#8217;s limitations are that it is a retrospective series&#44; with the possibility of unrecorded or undetected cases or with an alternative&#44; unidentified origin of the pneumatosis&#46; Future prospective studies would permit a more precise determination of the incidence and time to onset and resolution of this entity&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">Pneumatosis intestinalis in lung transplant recipients is a rare complication of uncertain origin that can occur over a long period of time after transplantation&#46; It has a characteristic radiological presentation of cystic&#47;expansive appearance&#44; which may or may not be associated with pneumoperitoneum and&#44; in the absence of symptoms or other associated alterations&#44; is of scant clinical relevance and can be managed without further diagnostic or therapeutic interventions&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Authorship&#47;collaborators</span><p id="par0130" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">1&#46;</span><p id="par0135" class="elsevierStylePara elsevierViewall">Responsible for the integrity of the study&#58; Vicente Belloch Ripoll&#233;s&#44; Carlos Francisco Mu&#241;oz N&#250;&#241;ez&#44; Luis Mart&#237;-Bonmat&#237;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">2&#46;</span><p id="par0140" class="elsevierStylePara elsevierViewall">Study conception&#58; Vicente Belloch Ripoll&#233;s&#44; Carlos Francisco Mu&#241;oz N&#250;&#241;ez&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">3&#46;</span><p id="par0145" class="elsevierStylePara elsevierViewall">Study design&#58; Vicente Belloch Ripoll&#233;s&#44; Carlos Francisco Mu&#241;oz N&#250;&#241;ez&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">4&#46;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Data collection&#58; Vicente Belloch Ripoll&#233;s&#44; Alilis Fontana Bellor&#237;n&#44; Ali Boukhoubza&#44; Mar&#237;a Parra Hern&#225;ndez&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">5&#46;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Data analysis and interpretation&#58; Vicente Belloch Ripoll&#233;s&#44; Carlos Francisco Mu&#241;oz N&#250;&#241;ez&#44; Alilis Fontana Bellor&#237;n&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">6&#46;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Statistical processing&#58; Vicente Belloch Ripoll&#233;s&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">7&#46;</span><p id="par0165" class="elsevierStylePara elsevierViewall">Bibliographic search&#58; Vicente Belloch Ripoll&#233;s&#44; Ali Boukhoubza&#44; Mar&#237;a Parra Hern&#225;ndez&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">8&#46;</span><p id="par0170" class="elsevierStylePara elsevierViewall">Editorial staff&#58; Vicente Belloch Ripoll&#233;s&#44; Luis Mart&#237;-Bonmat&#237;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">9&#46;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant contributions&#58; Carlos Francisco Mu&#241;oz N&#250;&#241;ez&#44; Alilis Fontana Bellor&#237;n&#44; Adela Batista Dom&#233;nech&#44; Luis Mart&#237;-Bonmat&#237;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">10&#46;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Approval of the final version&#58; Vicente Belloch Ripoll&#233;s&#44; Carlos Francisco Mu&#241;oz N&#250;&#241;ez&#44; Alilis Fontana Bellor&#237;n&#44; Adela Batista Dom&#233;nech&#44; Ali Boukhoubza&#59; Mar&#237;a Parra Hern&#225;ndez&#44; Luis Mart&#237;-Bonmat&#237;&#46;</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2022-12-21"
    "fechaAceptado" => "2023-01-17"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1855992"
          "palabras" => array:4 [
            0 => "Pneumatosis cystoides intestinalis"
            1 => "Pneumoperitoneum"
            2 => "Lung transplantation"
            3 => "Computed tomography"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1855993"
          "palabras" => array:4 [
            0 => "Neumatosis cistoide intestinal"
            1 => "Neumoperitoneo"
            2 => "Trasplante de pulm&#243;n"
            3 => "Tomograf&#237;a computarizada"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Pneumatosis intestinalis is a radiological finding characterized by the presence of gas in the bowel wall that is associated with multiple entities&#46; Our aim is to know its incidence in lung transplant patients&#44; its physiopathology and its clinical relevance&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A search of patients with pneumatosis intestinalis was performed in the database of the Lung Transplant Unit of our hospital&#46; The presence of pneumatosis after transplantation was confirmed in all of them and relevant demographic&#44; clinical and imaging variables were collected to evaluate its association and clinical expression&#44; as well as the therapeutic approach after the findings&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The incidence of pneumatosis intestinalis after lung transplantation in our center was 3&#46;1&#37; &#40;17&#47;546&#41;&#44; developing between 9 and 1270 days after transplantation &#40;mean&#44; 198 days&#59; median 68 days&#41;&#46; Most of the patients were asymptomatic or with mild symptoms&#44; without any major analytical alterations&#44; and with a cystic and expansive radiological appearance&#46; Pneumoperitoneum was associated in 70&#37; of the patients &#40;12&#47;17&#41;&#46; Conservative treatment was chosen in all cases&#46; The mean time to resolution was 389 days&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Pneumatosis intestinalis in lung transplant patients is a rare complication of uncertain origin&#44; which can appear for a very long period of time after transplantation&#46; It has little clinical relevance and can be managed without other diagnostic or therapeutic interventions&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">La neumatosis intestinal es un hallazgo radiol&#243;gico caracterizado por la presencia de gas en la pared del intestino que se asocia a m&#250;ltiples entidades&#46; Nuestro objetivo es conocer su incidencia en pacientes con trasplante pulmonar&#44; su fisiopatolog&#237;a y su relevancia cl&#237;nica&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; una b&#250;squeda de pacientes con neumatosis intestinal en la base de datos de la Unidad de Trasplante Pulmonar de nuestro hospital&#46; En todos ellos se confirm&#243; la presencia de neumatosis intestinal tras el trasplante y se recogieron variables demogr&#225;ficas&#44; cl&#237;nicas y de imagen relevantes para evaluar su asociaci&#243;n y expresividad cl&#237;nica&#44; as&#237; como la actitud terap&#233;utica tras los hallazgos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La incidencia de neumatosis intestinal postrasplante pulmonar en nuestro centro fue del 3&#44;1&#37; &#40;17&#47;546&#41;&#44; desarroll&#225;ndose entre 9 y 1270 d&#237;as tras el trasplante &#40;media&#44; 198 d&#237;as&#59; mediana 68 d&#237;as&#41;&#46; La mayor&#237;a de los pacientes estaban asintom&#225;ticos o con s&#237;ntomas leves&#44; sin grandes alteraciones anal&#237;ticas&#44; y con un aspecto radiol&#243;gico qu&#237;stico y expansivo&#46; Asoci&#243; neumoperitoneo en un 70&#37; &#40;12&#47;17&#41;&#46; Se opt&#243; por un tratamiento conservador en todos los casos&#46; El tiempo medio hasta la resoluci&#243;n fue de 389 d&#237;as&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La neumatosis intestinal en pacientes con trasplante pulmonar es una complicaci&#243;n rara&#44; de origen incierto&#44; que puede aparecer en un periodo de tiempo muy amplio tras el trasplante&#46; Tiene escasa relevancia cl&#237;nica y puede manejarse sin otras intervenciones diagn&#243;sticas ni terap&#233;uticas&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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          0 => array:3 [
            "identificador" => "at0005"
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            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Screening diagram and reasons for the exclusion of patients included in the series&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1661
            "Ancho" => 2007
            "Tamanyo" => 347364
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">58-year-old male with incidental finding of pneumatosis intestinalis and pneumoperitoneum under study for evaluation of lung transplantation &#40;patient no&#46;&#160;8&#41;&#46; Coronal reconstructions A and B&#41; and transverse sections C and D&#41; in lung window A and C&#41; and soft tissue window B and D&#41; of thoracic CT scan without intravenous contrast&#46; A and B&#41; Lung grafts without significant alterations&#46; C and D&#41; Extensive pneumatosis intestinalis is observed in the hepatic and splenic flexures of the colon &#40;arrows&#41;&#44; with localised air bubbles in the submucosa and serosa of the colon walls dissecting mesenteric fatty planes and delimiting the posterior aspect of the parietal peritoneum in the left hypochondrium &#40;arrowheads&#41;&#46; The study was completed with a contrast-enhanced abdomino-pelvic CT scan shown in <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1651
            "Ancho" => 2007
            "Tamanyo" => 217197
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">63-year-old woman with double-lung transplant for UIP-type fibrosis &#40;patient no&#46;&#160;12&#41;&#46; Abdominal CT scan with intravenous contrast performed after an incidental finding of colonic pneumatosis and pneumoperitoneum on thoracic CT scan performed to assess the sternal suture&#46; Transverse sections in soft tissue window A&#41; and lung B&#41; and coronal reconstructions with soft tissue window C&#41; and lung D&#41;&#46; Cystic pneumatosis intestinalis in the caecum&#44; ascending and transverse colon&#44; with expansive appearance and a large amount of air &#40;arrows&#41;&#46; Abundant pneumoperitoneum both right subdiaphragmatic and in the form of large bubbles dissecting the mesenteric fat &#40;asterisks&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 845
            "Ancho" => 2007
            "Tamanyo" => 175523
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Same patient as in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; 58-year-old male with an incidental finding of pneumatosis intestinalis and pneumoperitoneum after lung transplantation &#40;patient no&#46;&#160;8&#41;&#46; A&#41; Computed tomography topogram showing extensive pneumatosis intestinalis &#40;arrowheads&#41;&#46; Coronal reconstruction of computed tomography with intravenous contrast in soft tissue window B&#41; and lung window C&#41;&#46; B&#41; The soft tissue window permits the evaluation of radiological findings associated with ectopic air&#44; such as assessing correct uptake of the loops &#40;arrow&#41; and the absence of intra-abdominal free fluid&#46; C&#41; The lung window makes it possible to locate and assess the extent of both the pneumatosis intestinalis&#44; extending in this case along the entire colic frame from the caecum to the sigma &#40;arrowheads&#41;&#44; and the pneumoperitoneum&#44; which has a cystic and expansive appearance&#44; dissecting mesenteric fatty planes &#40;asterisk&#41;&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1634
            "Ancho" => 2007
            "Tamanyo" => 299590
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Example of pneumatosis intestinalis and pneumoperitoneum due to acute mesenteric ischaemia&#46; Cross-sectional images of venous phase intravenous contrast-enhanced computed tomography with soft tissue window A&#41; and lung window B&#41;&#59; and sagittal reconstruction of study performed in arterial phase C&#41;&#46; A&#41; Dilated&#44; thin-walled&#44; non-enhanced small bowel loops &#40;white arrowheads in A and C&#41;&#44; with free fluid &#40;asterisk in A and C&#41; and associated mesenteric venous pneumatosis &#40;arrows in A&#8211;C&#41;&#46; B&#41; Pneumatosis intestinalis &#40;black arrowheads&#41; and pneumoperitoneum &#40;dashed arrow&#41;&#46; C&#41; Critical stenosis of the superior mesenteric artery at its origin &#40;hollow arrow&#41;&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">AP CT&#58; abdomino-pelvic CT scan&#59; ASD&#58; atrial septal defect&#59; BP&#58; blood pressure&#59; CMV&#58; cytomegalovirus&#59; COPD&#58; chronic obstructive pulmonary disease&#59; CVA&#58; cerebrovascular accident&#59; DGM&#58; digestive medicine&#59; Dx&#58; diagnosis&#59; ECMO&#58; extracorporeal membrane oxygenation&#59; F&#58; female&#59; FBS&#58; fibrobronchoscopy&#59; GI&#58; gastrointestinal&#59; GS&#58; general surgery&#59; HCO3<span class="elsevierStyleSup">&#8722;</span>&#58; bicarbonate&#59; HR&#58; heart rate&#59; IC&#58; interconsultation&#59; IMV&#58; invasive mechanical ventilation&#59; M&#58; male&#59; MM&#58; mycophenolate mofetil&#59; NIVM&#58; non-invasive mechanical ventilation&#59; O<span class="elsevierStyleInf">2</span> sat&#46;&#58; oxygen saturation&#59; PEG&#58; percutaneous endoscopic gastrostomy&#59; PI&#58; pneumatosis intestinalis&#59; PHT&#58; pulmonary hypertension&#59; PTN&#58; parenteral nutrition&#59; PTE&#58; pulmonary thromboembolism&#59; Qx&#58; surgery&#59; Rx&#58; X-ray&#59; Temp&#46;&#58; temperature&#59; Tmt&#58; treatment&#59; Tx&#58; transplantation&#59; UIP&#58; usual interstitial pneumonia&#59; VSD&#58; ventricular septal defect&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient &#40;inpatient or outpatient&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age&#44; sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Indication&#59; type of Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Postoperative complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Time from Tx to PI &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Symptoms&#59; signs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vital signs &#40;BP&#44; HR&#44; O<span class="elsevierStyleInf">2</span> sat&#46;&#44; Temp&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Laboratory&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Signs of rejection<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Signs of pulmonary or GI infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Immunosuppressant medication &#40;drug&#44; dose&#47;24&#160;h and blood levels&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type and indication of the first test in which PI was diagnosed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Radiological findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Distribution of PI in abdomino-pelvic CT scans&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Attitude and time to resolution &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 Outpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#44; F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Congenital heart disease &#40;VSD&#41; and pulmonary hypertension&#59; cardiopulmonary therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMV re-intubation&#59; tracheostomy&#59; PTN&#59; haemorrhagic CVA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">289&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No pain&#59; abdominal distension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 145&#47;87&#160;mmHg&#59; HR 87&#160;bpm&#59; O<span class="elsevierStyleInf">2</span> sat&#46; 99&#37;&#59; Temp&#46; 36&#46;5&#160;&#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methylprednisolone &#40;16&#160;mg&#41;&#59; cyclosporine &#40;375&#160;mg&#59; 291&#46;5&#160;ng&#47;mL&#41; MM &#40;1000&#160;mg&#59; 0&#46;8&#160;&#181;g&#47;mL&#44; infratherapeutic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abdomino-pelvic CT scan&#59; referred from another hospital for pneumoperitoneum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis intestinalis and pneumoperitoneum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ascending colon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Indication AP CT scan&#59; IC to GS&#59; expectant management&#44; no Qx&#59; &#47;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 Inpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#44; F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary ciliary dyskinesia&#59; double-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">875&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No pain&#59; physical examination normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 113&#47;74&#160;mmHg&#59; HR 66&#160;bpm&#59; O<span class="elsevierStyleInf">2</span> sat&#46; 96&#37;&#59; Temp&#46; 36&#46;8&#160;&#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leukocytosis &#40;12&#46;26&#160;&#215;&#160;10<span class="elsevierStyleSup">3</span>&#47;&#181;L&#41; with neutrophilia &#40;10&#46;42&#160;&#215;&#160;10<span class="elsevierStyleSup">3</span>&#47;&#181;L&#41;&#59; CRP 160&#160;mg&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&#44; viral pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prednisone &#40;10&#160;mg&#41;&#59; azathioprine &#40;100&#160;mg&#41;&#59; tacrolimus &#40;8&#160;mg&#59; 12&#46;2&#160;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest abdomen and pelvis CT scan&#59; assessment of septic foci&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis intestinalis&#44; free fluid viral pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caecum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No CT scan&#59; IC to DM &#40;Digestive Medicine&#41;&#59; domperidone treatment&#44; no Qx&#59; 119 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 Outpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44; F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Congenital heart disease &#40;ASD&#41; and PHT&#59; heart and double-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PTE&#59; prolonged NIMV&#59; bacterial pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No pain&#59; abdominal distension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 123&#47;83&#160;mmHg&#59; HR 75&#160;bpm&#44; O<span class="elsevierStyleInf">2</span> sat&#46; 98&#37;&#44; Temp&#46; 36&#46;6&#160;&#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prednisone &#40;10&#160;mg&#41;&#44; tacrolimus &#40;16&#160;mg&#59; 11&#46;2&#160;ng&#47;mL&#41;&#59; MM &#40;360&#160;mg&#59; 0&#46;7&#160;&#181;g&#47;mL&#44; infratherapeutic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest CT scan&#59; previous PTE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis intestinalis in hepatic flexure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#47;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No CT scan&#44; no IC&#59; expectant management&#44; no Qx&#59; 136 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 Inpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UIP-type pulmonary fibrosis&#160;&#43;&#160;PHT&#59; double-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CMV replication&#59; multiple FBS&#59; aspergillus infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No pain&#59; physical examination normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 107&#47;70&#160;mmHg&#59; HR 81&#160;bpm&#59; O<span class="elsevierStyleInf">2</span> sat&#46; 98&#37;&#59; Temp&#46; 35&#46;4&#160;&#176;C&#59;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methylprednisolone &#40;20&#160;mg&#41;&#59; tacrolimus &#40;4&#160;mg&#59; 10&#46;1&#160;ng&#47;mL&#41;&#59; MM &#40;3000&#160;mg&#59; 3&#160;&#181;g&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest CT scan&#59; assessment of transplant status&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis intestinalis in hepatic flexure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#47;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No CT scan&#44; no IC&#59; expectant management&#44; no Qx&#59; 154 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 Outpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cystic fibrosis&#59; double-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1270&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No pain&#59; physical examination normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#47;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prednisone &#40;10&#160;mg&#41;&#44; tacrolimus &#40;3&#160;mg&#59; 7&#46;3&#160;ng&#47;mL&#41;&#59; everolimus &#40;3&#160;mg&#59; 8&#46;8&#160;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest CT scan&#59; suspected bronchiolitis obliterans syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis intestinalis hepatic flexure and pneumoperitoneum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#47;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No CT scan&#44; no IC&#59; expectant management&#44; no Qx&#59; 1379 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 Inpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cystic fibrosis&#59; double-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prolonged IMV&#59; left-side phrenic nerve paralysis&#59; PEG due to gastroparesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No pain&#59; abdominal distension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 128&#47;94&#160;mmHg&#59; HR 104&#160;bpm&#59; O<span class="elsevierStyleInf">2</span> sat&#46; 96&#37; Temp&#46; 36&#160;&#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CRP 48&#46;7&#160;mg&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methylprednisolone &#40;20&#160;mg&#41;&#59; tacrolimus &#40;5&#160;mg&#59; 8&#46;5&#160;ng&#47;mL&#41;&#59; MM &#40;1500&#160;mg&#59; 3&#46;4&#160;&#181;g&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest CT scan&#59; assess atelectasis detected on X-ray&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis intestinalis transverse colon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#47;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No CT scan&#44; no IC&#59; expectant management&#44; no Qx&#59; 105 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 Inpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumoconiosis &#40;silicosis&#41;&#59; right-sided one-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No pain&#59; physical examination normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 97&#47;57&#160;mmHg&#59; HR 86&#160;bpm&#59; O<span class="elsevierStyleInf">2</span> sat&#46; Temp&#46; 36&#46;7&#160;&#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leukocytosis &#40;17&#46;47&#160;&#215;&#160;10<span class="elsevierStyleSup">3</span>&#47;&#181;L&#41; with neutrophilia &#40;16&#46;48&#160;&#215;&#160;10<span class="elsevierStyleSup">3</span>&#47;&#181;L&#41;&#59; CRP 43&#46;9&#160;mg&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&#44; cough and pleural effusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methylprednisolone &#40;40&#160;mg&#41;&#59; tacrolimus &#40;3&#160;mg&#59; 23&#160;ng&#47;mL&#44; overdosage&#41;&#59; MM &#40;1000&#160;mg&#59; 3&#46;4&#160;&#181;g&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abdomino-pelvic CT scan&#59; desaturation&#44; leukocytosis and normal general condition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis intestinalis and pneumoperitoneum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ascending colon and hepatic flexure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Indication AP CT scan&#59; IC to GS&#59; expectant management&#44; no Qx&#59; 215 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 Outpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emphysema-type COPD&#59; double-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bronchial stenosis&#59; persistent air leak&#59; multiple FBS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">169&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vomiting&#44; increased stool rhythm&#59; physical examination normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 136&#47;66&#160;mmHg&#59; HR 67&#160;bpm&#59; O<span class="elsevierStyleInf">2</span> sat&#46; 98&#37;&#59; Temp&#46; 36&#46;2&#160;&#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prednisone &#40;5&#160;mg&#41;&#59; tacrolimus &#40;2&#160;mg&#59; 10&#46;9&#160;ng&#47;mL&#41;&#59; MM &#40;1000&#160;mg&#59; 0&#46;9&#160;&#181;g&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest CT scan&#59; assess airway stenosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis intestinalis and pneumoperitoneum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caecum&#44; ascending colon&#44; hepatic flexure&#44; transverse&#44; splenic flexure&#44; descending&#44; sigmoid&#44; and rectum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Indication AP CT scan&#59; IC to DGM&#59; expectant management&#44; no Qx&#59; indication CT scan in 1&#8211;3 months&#59; 75 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 Outpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UIP-type pulmonary fibrosis&#59; right-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No pain&#59; physical examination normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 115&#47;66&#160;mmHg&#59; HR 75&#160;bpm&#59; O<span class="elsevierStyleInf">2</span> sat&#46; 97&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Biopsy&#58; acute cellular rejection &#40;A1&#8722;2&#41; and inflammatory bronchiolitis &#40;B1R&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methylprednisolone &#40;16&#160;mg&#41;&#59; tacrolimus &#40;3&#160;mg&#59; 15&#46;6&#160;ng&#47;mL&#41;&#59; MM &#40;3000&#160;mg&#59; 3&#46;1&#160;&#181;g&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest X-ray&#59; assessment of transplant status&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatic and splenic flexure pneumatosis and pneumoperitoneum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis resolved at time of CT scan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Indication AP CT scan&#59; no IC&#59; expectant management&#44; no Qx&#59; 1591 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 Outpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pulmonary fibrosis&#44; double-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tracheostomy&#59; prolonged IMV&#59; right phrenic nerve paralysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No pain&#59; physical examination normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 115&#47;77&#160;mmHg&#59; HR 73&#160;bpm&#59; O<span class="elsevierStyleInf">2</span> sat&#46; 96&#37;&#59; Temp&#46; 36&#46;6&#160;&#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prednisone &#40;10&#160;mg&#41;&#59; tacrolimus &#40;4&#160;mg&#59; 11&#46;1&#160;ng&#47;mL&#41;&#59; MM &#40;2000&#160;mg&#59; 1&#46;1&#160;&#181;g&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest CT scan&#59; functional respiratory impairment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis intestinalis and pneumoperitoneum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ascending colon and hepatic flexure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Indication AP CT scan&#59; no IC&#59; expectant management&#44; no Qx&#59; 368 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 Inpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UIP type pulmonary fibrosis&#59; double-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Haemothorax&#59; post-surgical ECMO&#59; tracheostomy&#59; heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No pain&#59; physical examination normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 125&#47;82&#160;mmHg&#59; HR 91&#160;bpm&#59; O<span class="elsevierStyleInf">2</span> sat&#46; 95&#37;&#59; Temp&#46; 36&#46;1&#160;&#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCR 17&#160;mg&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methylprednisolone &#40;8&#160;mg&#41;&#59; tacrolimus &#40;4&#160;mg&#59; 10&#46;6&#160;ng&#47;mL&#41;&#59; MM &#40;500&#160;mg&#59; 0&#46;7&#160;&#181;g&#47;mL infratherapeutic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest CT scan&#59; recurrent pleural effusion with signs of organisation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis intestinalis and pneumoperitoneum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ascending and transverse colon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Indication AP CT scan&#59; no HF&#59; expectant management&#44; no Qx&#59; 73 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 Inpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44; F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UIP type pulmonary fibrosis&#59; double-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gastroparesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nausea&#44; diarrhoea&#44; gastroparesis&#44; bloated abdomen&#44; discomfort on deep epigastric palpation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 125&#47;81&#160;mmHg&#59; HR 80&#160;bpm&#59; O<span class="elsevierStyleInf">2</span> sat&#46; 94&#37;&#59; Temp&#46; 36&#46;1&#160;&#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Biopsy&#58; no signs of acute cellular rejection &#40;A0&#41; and inflammatory bronchiolitis &#40;B1R&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gastroparesis&#44; one vomiting and diarrhoea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methylprednisolone &#40;40&#160;mg&#41;&#59; tacrolimus &#40;16&#160;mg&#59; 17&#46;4&#160;ng&#47;mL&#44; supratherapeutic&#41;&#59; MM &#40;2000&#160;mg&#59; 1&#46;9&#160;&#181;g&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest CT scan&#59; assess sternal suture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis intestinalis and pneumoperitoneum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Terminal ileum&#44; caecum&#44; ascending and transverse colon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Indication AP CT scan&#59; IC to DGM&#59; domperidone Tt&#46;&#44; no Qx&#59; &#47;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 Inpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Idiopathic pulmonary fibrosis&#59; left single-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No pain&#59; physical examination normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 145&#47;72&#160;mmHg&#59; HR 83&#160;bpm&#59; O<span class="elsevierStyleInf">2</span> sat&#46; 99&#37;&#59; Temp&#46; 36&#46;4&#160;&#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methylprednisolone &#40;20&#160;mg&#41;&#59; tacrolimus &#40;6&#46;5&#160;mg&#59; 8&#46;9&#160;ng&#47;mL&#44; infratherapeutic&#41;&#59; MM &#40;3000&#160;mg&#59; 4&#46;2&#160;&#181;g&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest CT scan&#59; rule out thoracotomy dehiscence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis intestinalis ascending colon&#44; hepatic flexure and transverse and pneumoperitoneum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#47;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No CT scan&#44; no IC&#59; expectant management&#44; no Qx&#59; 72 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 Inpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44; F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cystic fibrosis&#59; double-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wound infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Right flank pain&#44; diarrhoea&#59; guarding on examination right flank&#44; no peritoneal irritation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 88&#47;51&#160;mmHg&#59; HR 112&#160;bpm&#59; O<span class="elsevierStyleInf">2</span> sat&#46; 100&#37;&#59; Temp&#46; 37&#160;&#176;C&#59;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leukocytosis &#40;21&#46;30&#160;&#215;&#160;10<span class="elsevierStyleSup">3</span>&#47;&#181;L&#41; with neutrophilia &#40;19&#46;52&#160;&#215;&#160;10<span class="elsevierStyleSup">3</span>&#47;&#181;L&#41;&#59; CRP 381&#160;mg&#47;L&#59; procalcitonin 18&#46;32&#160;ng&#47;L&#59; lactate 1&#46;8&#160;mmol&#47;L&#59; HCO3<span class="elsevierStyleSup">&#8722;</span> 21&#46;5&#160;mmol&#47;L&#59; pH 7&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">C&#46; difficile</span> pancolitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prednisone &#40;30&#160;mg&#41;&#59; tacrolimus &#40;5&#160;mg&#59; 6&#46;6&#160;ng&#47;mL&#44; infratherapeutic&#41;&#59; MM &#40;3000&#160;mg&#59; 1&#46;6&#160;&#181;g&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abdomino-pelvic CT scan&#59; Clinical and analytical deterioration in a patient with AGE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis intestinalis&#44; portal pneumatosis&#44; free fluid&#44; wall thickening colon&#58; <span class="elsevierStyleItalic">C&#46; difficile</span> pancolitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caecum&#44; ascending colon&#44; hepatic flexure and transverse colon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IC to GS&#59; antibiotic Tmt&#46; with fidaxomicin&#44; no Qx&#46; Dx <span class="elsevierStyleItalic">C&#46; difficile</span> pancolitis&#59; 3 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 Inpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emphysema type COPD&#59; right single-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lithium poisoning&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No pain&#44; abdominal discomfort with ingestion&#59; physical examination normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 115&#47;82&#160;mmHg&#59; HR 103&#160;bpm&#59; O<span class="elsevierStyleInf">2</span> sat&#46; 99&#37;&#59; Temp&#46; 35&#46;4&#160;&#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Clinical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methylprednisolone &#40;40&#160;mg&#41;&#59; tacrolimus &#40;4&#160;mg&#59; 17&#46;4&#160;ng&#47;mL&#44; supratherapeutic&#41;&#59; MM &#40;540&#160;mg&#59; 7&#46;6&#160;&#181;g&#47;mL&#44; supratherapeutic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest CT scan&#59; assessment of transplant status&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis intestinalis and pneumoperitoneum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caecum&#44; ascending colon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Indication AP CT scan&#59; IC to DGM and GS&#59; expectant management&#44; no Qx&#59; 384 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 Inpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emphysema-type COPD&#59; double-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Air leak&#59; thoracotomy and sternotomy surgical dehiscence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subcutaneous emphysema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 126&#47;60&#160;mmHg&#59; HR 86&#160;bpm&#59; O<span class="elsevierStyleInf">2</span> sat&#46; 95&#37;&#59; Temp&#46; 37&#160;&#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leukocytosis &#40;15&#160;&#215;&#160;10<span class="elsevierStyleSup">3</span>&#47;&#181;L&#41; with neutrophilia &#40;12&#46;77&#160;&#215;&#160;10<span class="elsevierStyleSup">3</span>&#47;&#181;L&#41;&#59; CRP 27&#46;5&#160;mg&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methylprednisolone &#40;60&#160;mg&#41;&#59; tacrolimus &#40;6&#160;mg&#59; 12&#46;1&#160;ng&#47;mL&#41;&#59; MM &#40;1000&#160;mg&#59; 7&#46;5&#160;&#181;g&#47;mL&#44; supratherapeutic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest CT scan&#59; assessment of transplant status&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gastric pneumatosis and pneumoperitoneum&#46; Bilateral pneumothorax&#44; subcutaneous emphysema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#47;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No CT scan&#59; IC to DGM&#59; surgical Trt&#46; for air leak and surgical dehiscence&#59; 22 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 Inpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44; M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emphysema-type COPD&#59; double-lung Tx&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No pain&#59; physical examination normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BP 122&#47;85&#160;mmHg&#59; HR 88&#160;bpm&#59; O<span class="elsevierStyleInf">2</span> sat&#46; 100&#37;&#59; Temp&#46; 36&#160;&#176;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leukocytosis &#40;13&#160;&#215;&#160;10<span class="elsevierStyleSup">3</span>&#160;&#181;&#47;L&#41; with neutrophilia &#40;11&#160;&#215;&#160;10<span class="elsevierStyleSup">3</span>&#160;&#181;&#47;L&#41;&#59; CRP 7&#46;6&#160;mg&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Methylprednisolone &#40;50&#160;mg&#41;&#59; tacrolimus &#40;10&#160;mg&#59; 11&#46;1&#160;ng&#47;mL&#41;&#59; MM &#40;3000&#160;mg&#59; 2&#46;7&#160;&#181;g&#47;mL&#44; supratherapeutic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chest CT scan&#59; assessment of transplant status&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pneumatosis intestinalis ascending colon&#44; hepatic flexure&#44; transverse&#44; splenic flexure and descending and pneumoperitoneum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#47;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No CT scan&#59; IC to DGM&#59; expectant management&#44; no Qx&#59; &#47;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3610202.png"
              ]
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Signs of rejection&#58; defined as the occurrence of any clinical or pathological event that resulted in the application of high-dose steroid boluses&#46; Pathological classification of pulmonary rejection of the International Society for Heart and Lung Transplantation &#40;ISHLT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Main clinical and radiological data of our patient series&#46;</p>"
        ]
      ]
    ]
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:17 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Natural history&#44; clinical pattern&#44; and surgical considerations of pneumatosis intestinalis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;N&#46; Khalil"
                            1 => "S&#46; Huber-Wagner"
                            2 => "R&#46; Ladurner"
                            3 => "A&#46; Kleespies"
                            4 => "M&#46; Siebeck"
                            5 => "W&#46; Mutschler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/2047-783X-14-6-231"
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Med"
                        "fecha" => "2009"
                        "volumen" => "14"
                        "paginaInicial" => "231"
                        "paginaFinal" => "239"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Benign pneumatosis intestinalis after bilateral lung transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46;Y&#46; Ling"
                            1 => "A&#46;M&#46; Zafar"
                            2 => "L&#46;F&#46; Angel"
                            3 => "A&#46;L&#46; Mumbower"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bcr-2015-210701"
                      "Revista" => array:2 [
                        "tituloSerie" => "BMJ Case Rep"
                        "fecha" => "2015"
                      ]
                    ]
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                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pneumatosis cystoides intestinalis in lung transplant recipients&#58; three cases report and literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "W&#46;L&#46; Chen"
                            1 => "L&#46; Zhao"
                            2 => "L&#46;J&#46; Guo"
                            3 => "C&#46;Y&#46; Liang"
                            4 => "J&#46;Y&#46; Chen"
                            5 => "W&#46;H&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3760/cma.j.cn112147-20220106-00022"
                      "Revista" => array:5 [
                        "tituloSerie" => "Chin J Tuberc Respir Dis"
                        "fecha" => "2022"
                        "volumen" => "45"
                        "paginaInicial" => "671"
                        "paginaFinal" => "676"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
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Article information
ISSN: 21735107
Original language: English
DOI:10.1016/j.rxeng.2023.01.013
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