Learning objectives
Describe the main radiological signs suggestive of in febrile neutropenic onco-haematological patients.
Background
Lung invasive mould diseases (IMDs) are an important cause of morbidity and mortality in immunocompromised patients with severe neutropenia (due to haematological neoplasms or medullary aplasia).
Taking into account that the prognosis depends on the timeliness of treatment the early detection of IMD is crucial.
(1-4)
In 2008,
the European Organization for Research and Treatment of Cancer / Mycoses Study Group (EORTC / MSG) proposed three levels of diagnostic probability for the diagnosis of IMD.
(5)
Proven IMD: histological evidence of fungal invasion of the...
Findings and procedure details
Among the "historical" signs of IMD,
the best known is the HS (figure 1),
defined as a solid parenchymal nodule with a peripheral halo of ground-glass; it corresponds histopathologically to a pulmonary infarction surrounded by a halo of alveolar hemorrhage.
In angioinvasive mycoses,
fungal hyphae invade the medium and small-sized pulmonary vessels causing thrombosis and hemorrhagic infarction with coagulative necrosis of the pulmonary parenchyma.
(8) The incidence of HS in patients with IMD is particularly high during the initial phases; in fact,
over time,
the...
Conclusion
The early diagnosis of IMD has a fundamental importance because the outcome of the febrile neutropenic patient depends on it.
Apart from HS and the ACS,
the historical signs of IMD,
we must remember that HRCT allows us to identify other signs with high specificity,
such as RHS and HyS,
which however are not included in the EORTC/MSG criteria for the diagnosis of IMD.
The use of the CTPA allows to document the VOS which plays a role important in the diagnosis of IMD because...
Personal information
Antonio Bruno M.D.
Dept.
of Experimental,
Diagnostic and Specialty Medicine – DIMES,
University of Bologna,
S.Orsola-Malpighi Hospital,
via Giuseppe Massarenti 9,
40138,
Bologna,
Italy
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Arch...
