Faculty Opinions recommendation of Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign.

Invasive pulmonary aspergillosis (IPA) predominantly occurs in severely neutropenic immunocompromised subjects. The occurrence of acute IPA after brief but massive exposure to Aspergillus conidia in previously healthy subjects has been documented, although only six such cases have been reported. The diagnosis was delayed in all six of the affected patients, five of whom died. We report the case of a 50-year-old HIV-negative male, a water pipeline maintenance worker, who presented with acute-onset dyspnea and fever one day after working for 2 h in a deep pit containing polluted, muddy water. Over a one-month period, his general condition deteriorated markedly, despite antibiotic therapy. Imaging showed bilateral diffuse nodules with cavitation, some of which were surrounded by ground-glass opacity suggestive of a halo sign (a hallmark of IPA). Cultures (of sputum/bronchial aspirate samples) and serology were positive for Aspergillus fumigatus. After being started on itraconazole, the patient improved. We conclude that massive exposure to Aspergillus conidia can lead to acute IPA in immunocompetent subjects.

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The reversed halo sign. Another CT finding useful for distinguish invasive pulmonary aspergillosis and pulmonary lymphoma

European Journal of Radiology ◽

10.1016/j.ejrad.2011.03.086 ◽

2011 ◽

Vol 79 (2) ◽

pp. e96-e97 ◽

Cited By ~ 5

Author(s):

Edson Marchiori ◽

Myrna C.B. Godoy ◽

Gláucia Zanetti ◽

Bruno Hochhegger ◽

Rosana Souza Rodrigues

Keyword(s):

Invasive Pulmonary Aspergillosis ◽

Pulmonary Aspergillosis ◽

Halo Sign ◽

Pulmonary Lymphoma ◽

Reversed Halo Sign ◽

Ct Finding

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The value of the chest computed tomography halo sign in the diagnosis of invasive pulmonary aspergillosis. An autopsy-based retrospective study of 48 patients

Mycoses ◽

10.1046/j.1439-0507.2002.00770.x ◽

2002 ◽

Vol 45 (7-8) ◽

pp. 287-294 ◽

Cited By ~ 33

Author(s):

M. Kami ◽

Y. Kishi ◽

T. Hamaki ◽

M. Kawabata ◽

T. Kashima ◽

...

Keyword(s):

Computed Tomography ◽

Retrospective Study ◽

Invasive Pulmonary Aspergillosis ◽

Pulmonary Aspergillosis ◽

Chest Computed Tomography ◽

Halo Sign

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Increasing Volume and Changing Characteristics of Invasive Pulmonary Aspergillosis on Sequential Thoracic Computed Tomography Scans in Patients With Neutropenia

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.1.253 ◽

2001 ◽

Vol 19 (1) ◽

pp. 253-259 ◽

Cited By ~ 416

Author(s):

Denis Caillot ◽

Jean-Francois Couaillier ◽

Alain Bernard ◽

Olivier Casasnovas ◽

David W. Denning ◽

...

Keyword(s):

Computed Tomography ◽

Surgical Approach ◽

Invasive Pulmonary Aspergillosis ◽

Pulmonary Involvement ◽

Median Number ◽

Pulmonary Aspergillosis ◽

Halo Sign ◽

Thoracic Computed Tomography ◽

Computed Tomography Scans ◽

Median Volume

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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Radiologic-Pathologic Correlation of the CT Halo Sign in Invasive Pulmonary Aspergillosis

Journal of Computer Assisted Tomography ◽

10.1097/00004728-198705000-00033 ◽

1987 ◽

Vol 11 (3) ◽

pp. 534-536 ◽

Cited By ~ 77

Author(s):

Ralph H. Hruban ◽

Moulay A. Meziane ◽

Elias A. Zerhouni ◽

Paul S. Wheeler ◽

J. Stephen Dumler ◽

...

Keyword(s):

Invasive Pulmonary Aspergillosis ◽

Pulmonary Aspergillosis ◽

Pathologic Correlation ◽

Halo Sign

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Clinical manifestations and outcome analysis of invasive pulmonary aspergillosis infection: a retrospective study in 43 nonneutropenic patients

Journal of International Medical Research ◽

10.1177/0300060519874901 ◽

2019 ◽

Vol 47 (11) ◽

pp. 5680-5688

Author(s):

Lihong Zhang ◽

Chunli Che

Keyword(s):

Early Stage ◽

Invasive Pulmonary Aspergillosis ◽

Clinical Manifestations ◽

Ground Glass Opacity ◽

Pulmonary Aspergillosis ◽

Halo Sign ◽

Mold Exposure ◽

Wbc Count ◽

Lung Ct ◽

Central Airway

Objective To investigate clinical characteristics of early-onset invasive pulmonary aspergillosis (IPA) in nonneutropenic patients. Methods Retrospective analysis was used to investigate clinical manifestations and auxiliary examination characteristics in 43 patients with IPA and 51 patients with community-acquired pneumonia in the early stage. Results Risk factors of IPA were dust and mold exposure, bronchiectasis, old pulmonary tuberculosis, and nasosinusitis. The incidence rate of complex clinical manifestations was 60.47% during the first week of IPA. The incidence rate of white blood cell (WBC) count >20.0 × 109/L was 51.16%. Lung CT findings indicated incidence rates of single or multiple nodules with a halo sign and central airway expansion with ground glass opacity were 27.9% and 37.21%, respectively. Mortality rates of patients with IPA given empirical and targeted antifungal treatments were 12.0% and 42.9%, respectively. Conclusions Bronchiectasis, old pulmonary tuberculosis, nasosinusitis, and dust and mold exposure may increase the risk of IPA. Single or multiple nodules with a halo sign and central airway expansion with ground glass opacity may be early-stage lung CT findings in patients with IPA. A WBC count >20.0 × 109/L may aid in early diagnosis, and empirical antifungal therapy may reduce mortality in patients with IPA.

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