A Caucasian male underwent a liver transplant for hepatocarcinoma and thereafter performed several CT scans as oncological follow-up. Chest CT scans were unremarkable (figure 1A). After 2 years, he was referred to the pulmonologist for the appearance of bilateral ground glass opacities (GGO) (figure 1B). The patient was treated with everolimus and tacrolimus as immunosuppressants for the graft. At the pulmonary evaluation, the patient was asymptomatic from a respiratory perspective, with normal oxygen saturation in room air (98%) and an unremarkable chest auscultation. He underwent pulmonary function tests, which showed normal static and dynamic volumes, and only a mild reduction of carbon monoxide diffusion (69%). Consequently, it was decided to repeat the chest CT after 3 months.

The second CT scan showed a worsening of bilateral GGO associated with some consolidations and crazy-paving-like areas (figure 1C). The patient remained asymptomatic for respiratory symptoms. Following a multidisciplinary…