CT findings of fungal pneumonia with emphasis on aspergillosis

Abstract

Fungal pneumonias are increasingly common in the population of immunosuppressed patients. The diagnosis of fungal pneumonias represents a challenge for clinicians, and the morbidity and mortality of these infections are high in immunocompromised patients. CT findings may be nonspecific; however, in the appropriate clinical setting, they may suggest and even help establish the specific diagnosis. This article provides an overview about the CT findings and possible differential diagnosis of the most common pulmonary fungal infections.

Imaging features of fungal pneumonia in haematopoietic stem cell transplant patients

“…The prophylactic use of "azole" medications (such as fluconazole) has significantly decreased the rate of Candida species infections (candidiasis) in HSCT patients. The appearance of candidiasis pneumonia overlaps significantly with those discussed previously: nodules, consolidation; possible ground-glass halo; and less common patterns include cavitations and miliary nodules (Figure 4) [6,27].…”

“…Patients who have undergone HSCT and are experiencing pulmonary complications may not necessarily pres- 1). Persistent fevers, cough, chest pain, and haemoptysis are a few of the clinical features that can be encountered in cases of fungal pneumonia, which may trigger further investigation with radiological studies: chest radiographs and/or computed tomography (CT) [6].…”

“…The clinical manifestation of invasive pulmonary aspergillosis usually occurs 2 weeks after the most profound neutropaenia [14]. From a radiologic stance, we will focus on IPA, which has 2 main subtypes: angioinvasive aspergillosis and airway-invasive aspergillosis [3,6,8]. The most common initial manifestations of IPA include solid macronodules (≥ 1 cm in diameter, present in 94% of patients) with a surrounding halo of ground-glass attenuation classically known as the "halo sign" (present in 61% of patients) (Figure 2) [6,[15][16][17][18].…”

“…From a radiologic stance, we will focus on IPA, which has 2 main subtypes: angioinvasive aspergillosis and airway-invasive aspergillosis [3,6,8]. The most common initial manifestations of IPA include solid macronodules (≥ 1 cm in diameter, present in 94% of patients) with a surrounding halo of ground-glass attenuation classically known as the "halo sign" (present in 61% of patients) (Figure 2) [6,[15][16][17][18]. The halo sign is a nonsensitive but highly suggestive finding of early IPA in HSCT recipients [15,19] and represents a distinct nodule with infarction, necrosis, and alveolar haemorrhage [15].…”

“…Fungal pneumonia is not frequently seen amongst the general population, with exceptions of certain endemic regions of the world (for example the Mississippi River Valley, Ohio River Valley, Southwestern United States, etc.) [ 6 ]. However, in the immunosuppressed population, fungal pneumonia becomes a greater concern and can reflect opportunistic ( Candida, Aspergillus , or Mucormycosis species) or endemic origin ( Blastomyces dermatitidis, Coccidiodes immitis , and Histoplasma caspulatum ) of infection ( Table 1 ).…”