Computed Tomography in Invasive Pulmonary Aspergillosis

PURPOSE: In patients with neutropenia, thoracic computed tomography (CT) halo and air-crescent signs are recognized as major indicators of invasive pulmonary aspergillosis (IPA). Nevertheless, the exact timing of CT images is not well known.PATIENTS AND METHODS: Seventy-one thoracic CT scans were analyzed in 25 patients with neutropenia with surgically proven IPA.RESULTS: On the first day of IPA diagnosis with early CT scan (d0), a typical CT halo sign was observed in 24 of 25 patients. At that time, the median number of thoracic lesions was two (range, one to six), and pulmonary involvement was bilateral in 12 cases. The halo sign was present in 68%, 22%, and 19% of cases on d3, d7, and d14, respectively. Similarly, the air-crescent sign was seen in 8%, 28%, and 63% of cases on the same days. Otherwise, a nonspecific air-space consolidation aspect was seen in 31%, 50%, and 18% of cases on the same days. The analysis of calculated aspergillary volumes on CT showed that, despite antifungal treatment, the median volume of lesions increased four-fold from d0 to d7, whereas it remained stable from d7 to d14. Overall, 21 patients (84%) were cured by the medical-surgical approach.CONCLUSION: In patients with neutropenia, CT halo sign is a highly effective modality for IPA diagnosis. The duration of the halo sign is short, and it demonstrates the value of early CT. The increase of the aspergillosis size on CT in the first days after IPA diagnosis is not correlated with a pejorative immediate outcome when using a combined medical-surgical approach.

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The role of multidetector computed tomography in early diagnosis of invasive pulmonary aspergillosis in patients with febrile neutropenia undergoing hematopoietic stem cell transplantation

Turkish Journal of Hematology ◽

10.5152/tjh.2011.78 ◽

2011 ◽

Author(s):

Nazan Ciledag ◽

Kemal Arda ◽

Bilgin Kadri Aribas ◽

Ali Irfan Emre Tekgunduz ◽

Fevzi Altuntas

Keyword(s):

Computed Tomography ◽

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Early Diagnosis ◽

Febrile Neutropenia ◽

Stem Cell Transplantation ◽

Invasive Pulmonary Aspergillosis ◽

Pulmonary Aspergillosis ◽

Hematopoietic Stem

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Invasive Pulmonary Aspergillosis

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0039-3401990 ◽

2020 ◽

Vol 41 (01) ◽

pp. 080-098 ◽

Cited By ~ 4

Author(s):

Marie-Pierre Ledoux ◽

Blandine Guffroy ◽

Yasmine Nivoix ◽

Célestine Simand ◽

Raoul Herbrecht

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Amphotericin B ◽

Critically Ill ◽

Critically Ill Patients ◽

Immunosuppressive Agents ◽

Invasive Pulmonary Aspergillosis ◽

Solid Organ ◽

Pulmonary Aspergillosis ◽

Hematopoietic Stem

AbstractInvasive pulmonary aspergillosis (IPA) remains difficult to diagnose and to treat. Most common risk factors are prolonged neutropenia, hematopoietic stem cell or solid organ transplantation, inherited or acquired immunodeficiency, administration of steroids or other immunosuppressive agents including monoclonal antibodies and new small molecules used for cancer therapy. Critically ill patients are also at high risk of IPA. Clinical signs are unspecific. Early computed tomography (CT)-scan identifies the two main aspects, angioinvasive and airway invasive aspergillosis. Although CT-scan findings are not fully specific they usually allow early initiation of therapy before mycological confirmation of the diagnosis. Role of 18F-fludeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) is discussed. Confirmation is based on microscopy and culture of respiratory samples, histopathology in case of biopsy, and importantly by detection of Aspergillus galactomannan using an immunoassay in serum and bronchoalveolar lavage fluid. Deoxyribonucleic acid detection by polymerase chain reaction is now standardized and increases the diagnosis yield. Two point of care tests detecting an Aspergillus glycoprotein using a lateral flow assay are also available. Mycological results allow classification into proven (irrespective of underlying condition), probable or possible (for cancer and severely immunosuppressed patients) or putative (for critically ill patients) IPA. New antifungal agents have been developed over the last 2 decades: new azoles (voriconazole, posaconazole, isavuconazole), lipid formulations of amphotericin B (liposomal amphotericin B, amphotericin B lipid complex), echinocandins (caspofungin, micafungin, anidulafungin). Results of main trials assessing these agents in monotherapy or in combination are presented as well as the recommendations for their use according to international guidelines. New agents are under development.

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Computed Tomography in Invasive Pulmonary Aspergillosis

Acta Radiologica ◽

10.1177/028418518903000604 ◽

1989 ◽

Vol 30 (6) ◽

pp. 587-590 ◽

Cited By ~ 4

Author(s):

G. Potente

Keyword(s):

Computed Tomography ◽

Early Recognition ◽

Invasive Pulmonary Aspergillosis ◽

Central Area ◽

Chest Ct ◽

Target Feature ◽

Pulmonary Aspergillosis ◽

Peripheral Ring ◽

Immunocompromised Hosts ◽

Peripheral Enhancement

Early recognition of invasive pulmonary aspergillosis and of other similar angiotrophic fungal pneumonias has been claimed in previous reports to be possible with computed tomography (CT) and may improve survival of immunocompromised hosts. Chest CT was performed, in the course of fungal pneumonia, in 11 leukemia patients with chemotherapy-induced neutropenia, either with (n=8) or without (n=5) contrast enhancement. Early (n=5, before the 7th day from the beginning of the clinical setting) chest CT always demonstrated one or more nodules or mass-like infiltrates surrounded by a halo of low attenuation. This halo was absent in middle (n=4, after 7 days) and later (n=4, after 15 days) CT examinations. The contrast-enhanced nodules or mass-like infiltrates showed a peripheral enhancement in 4/8 cases with a target feature (hyperdense peripheral ring and isodense central area). CT showed a non-specific enlargement of liver and spleen in 2 patients. Early chest CT should be used in the management of opportunistic pneumonias.

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