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 months)
- Unilateral or bilateral nodule,
mass or consolidation
- Typically the upper zones
- Adjacent pleural thickening
- Central necrotic area
- With or without cavitation
Differential diagnosis
- Pulmonary tuberculosis
- Pulmonary actinomycosis
- Pulmonary histoplasmosis
Ø Aspergilloma
- Preexisting cavity with a central soft tissue attenuating rounded masses surrounded by a crescent of air (air crescent sign)
- Dependent mobile mass (supine and prone position)
- Calcifications
- Adjacent pleural thickening
Differential diagnosis
- Non-small cell lung cancer
- Solitary pulmonary nodule
- Pulmonary tuberculosis
- Hydatid cyst
Ø Allergic bronchopulmonary aspergillosis (ABPA)
- Centrilobular nodules representing dilated and opacified bronchioles
- Central upper lobe saccular bronchiectasis involving segmental and subsegmental bronchi
- Mucoid impaction results in a bronchocoele (finger in glove sign)
Differential diagnosis
- Mucoid impaction secondary to bronchiectasis and an endobronchial lesion
- Cystic fibrosis
- Williams Campbell syndrome