Learning objectives
- Review the different forms of pulmonary involvement caused by Aspergillus fungal infection, clinical manifestations and risk groups;
- Describe the main radiological findings of the spectrum of pulmonary aspergillosis on high-resolution CT.
Background
Pulmonary aspergillosis is an infection caused by the fungus Aspergillus (usually A. fumigatus), which is ubiquitous in the soil and acquired by inhaling spores.
Clinical and radiological manifestations are determined by the host immune status and the existence of pulmonary damage. It is currently accepted that pulmonary aspergillosis can be subdivided into five types.
Findings and procedure details
Although controversial and constantly evolving, pulmonary aspergillosis can be subdivided into five main categories, each with different risk groups, clinical manifestations and radiographic findings:
- Aspergilloma (saprophytic or non-invasive aspergillosis), which arises in abnormal airways or pulmonary cavities and is the most common form;
- Allergic bronchopulmonary aspergillosis (ABPA), which affects patients with asthma and cystic fibrosis;
- Chronic necrotizing aspergillosis (or semi-invasive) described in patients with chronic pulmonary pathology and mild immunodeficiency;
- Invasive aspergillosis associated with markedly immunocompromised patients, which can be divided...
Conclusion
Pulmonary aspergillosis can have a broad spectrum of clinical presentations and can be fatal in severely immunosuppressed patients, so early and correct diagnosis is essential.
The radiologist plays an important role and should recognize the typical imaging findings of the different subtypes of pulmonary aspergillosis, but knowledge of the clinical context is crucial.
Personal information and conflict of interest
S. G. Teixeira; Viseu/PT - nothing to disclose P. G. J. Magalhaes; Viseu/PT - nothing to disclose F. Matos; Viseu/PT - nothing to disclose P. M. R. C. Patrão; Viseu/PT - nothing to disclose A. Figueiredo; Viseu/PT - nothing to disclose D. Silva; Viseu/PT - nothing to disclose
References
Franquet T, et al. Spectrum of Pulmonary Aspergillosis: Histologic, Clinical, and Radiologic Findings. RadioGraphics 2001; 21:825–837.
Thompson B, et al. Appearances of Pulmonary Aspergillosis. RadloGraphics 1995; 1 5: 1 2ı3- 1284.
Greene R. The radiological spectrum of pulmonary aspergillosis. Medical Mycology Supplement 1 2005, 43, S147/S154.
Sugino K, et al. Pathophysiological study of chronic necrotizing pulmonary aspergillosis, Jpn J Infect Dis. 2008; 61(6) - 450-3.
James C, et al. Chest Radiology: Patterns and Differential Diagnoses, Seventh Edition