Type:
Educational Exhibit
Keywords:
Leukaemia, Infection, Haematologic diseases, eLearning, Education, CT-Angiography, CT, Thorax, Haematologic
Authors:
A. Bruno, V. Cosi, F. Ragusa, G. Peta, G. Battista, C. Sassi; Bologna/IT
DOI:
10.26044/ecr2019/C-3029
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 lung (this level of certainty is rarely achieved because invasive procedures required to collect biological tissues are often contraindicated due to severe thrombocytopenia).
Probable IMD: pulmonary CT findings suggestive of IMD,
risk factors for fungal infections (e.g.
prolonged neutropenia) and microbiological evidence of fungal infection (positive culture or presence of galactomannan in the serum or in the bronchoalveolar lavage).
Cultures,
however,
have a relatively low sensitivity and the galactomannan antigen test may be impaired in patients receiving antifungal prophylaxis or antibiotic therapy.
(6-7)
Possible IMD: risk factors for fungal infections and pulmonary CT findings suggestive of IMD without any microbiological evidence of fungal infection.
As stated by EORTC/MSG guidelines,
CT is an important tool in the early detection of fungal lung infection in immunocompromised patients.
High Resolution-CT (HRCT) signs suggesting IMD include: halo sign (HS),
air crescent sign (ACS),
hypodense sign (HyS) and reversed halo sign (RHS).
Recently a further sign has been described,
the vessel occlusion sign (VOS),
visible at pulmonary angio-CT (CTPA).
CTPA also allows to improve the capability to detect the HyS.