Aspergillus in the respiratory system: Radiological appearance.

Congress:

ECR 2019

Poster Number:

C-2125

Type:

Educational Exhibit

Keywords:

Thorax, Lung, Management, CT, CT-High Resolution, Education, eLearning, Infection, Pathology

Authors:

E. Lambeets¹, R. Peters¹, B. Peters²; ¹Halle/BE, ²Edegem, Antwerpen/BE

DOI:

10.26044/ecr2019/C-2125

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-2125

Fig. 1: Axial CT image of the chest shows a right upper lobe nodule with surrounding...

Fig. 2: Axial CT image through the lung apices shows an thick walled cavitary right...

Fig. 3: Axial CT image through the lung shows a dependent opacity in a right upper lobe...

Fig. 4: Axial chest CT image shows central saccular bronchiectasis and a fleeting...

Learning objectives

Recognize the radiologic manifestations and patterns of pulmonary aspergillosis. Four types of pulmonary involvement can be distinguished: invasive aspergillosis, semi-invasive aspergillosis, allergic aspergillosis and aspergilloma. Review the differential diagnosis of pulmonary aspergillosis

Background

Aspergillosis is a mycotic disease caused by aspergillus. Aspergillus particularly affect immunocompromised individuals and structural abnormal lungs. The most important Aspergillus species are A. fumigatus, A. flavus and A. clavatus. Depending on the patients underlying immune status, the load of the organisms and the underlying condition of the lungs the infection can manifest as a variety of forms. Radiological investigations particularly chest Computed Tomography (CT) provides the easiest, rapid and decision making information. CT shows us typical patterns, extent and complications of aspergillus infection. Pulmonary...

Findings and procedure details

There are four types of pulmonary involvement. Typical thoracic manifestations on CT: Ø Invasive aspergillosis - Lobar or peribronchial consolidation - Centrilobular nodules - Nodules surrounded by a halo of ground-glass attenuation (CT-halo sign) - Wedge-shaped areas of consolidation (hemorrhagic infarcts) - Direct invasion into the adjacent chest wall or mediastinal structures in advanced cases Differential diagnosis - Other funcal infection - Bacterial pneumonia - Mycobacterial infection - Pulmonary emboli - Wegener granulomatosis - Hemorhagic metastases Ø Semi-invasive aspergillosis - Slow growing process (weeks to...

Conclusion

The radiologist has to be familiar with imaging findings of pulmonary aspergillosis and the differential diagnosis. Typicall imaging features and patterns on Chest CT will help to diagnose aspergillus infection early in course and improved outcomes.

Personal information

References

1. Webb RW, Higgins CB, Pulmonary infections. Thoracic Imaging Chapter 12:375-427 2. Chabi ML,Roche AG,Paugam A.,et al. Pulmonary aspergillosis. Diagn Interv Imaging,96(2015), pp.435-442 3. Verschakelen JA, De Wever W. Computed Tomography of the Lung – A pattern approach 4. Tomas Franquet et al. Spectrum of Pulmonary Aspergillosis: Histologic, Clinical and Radiological Findings. Radiographics 2001;21:825-837