CT of invasive pulmonary aspergillosis in children with cancer

Abstract

In treating cases of malignancy, the use of chemotherapy carries a high risk of lower respiratory tract infections, especially fungal pneumonopathy. This complication is a major cause of mortality and is often difficult to diagnose because of non-specific clinical or radiological changes, but the early recognition of invasive fungal disease is imperative. CT is an important non-invasive method for the detection and evaluation of opportunistic fungal infections. In these patients an improved survival rate can be achieved when early detection by CT leads to the prompt institution of high-dose antifungal therapy. We illustrate the spectrum of CT findings of invasive pulmonary aspergillosis encountered in children with cancer. These patients had previously been treated with high-dose chemotherapy with or without bone marrow rescue, and underwent radiological examinations because of clinical evidence of pneumonopathy. Representative cases demonstrate the clinical applications of CT in the evaluation and management of invasive fungal disease.

Aspergilosis invasora multisistémica en un niño inmunocompetente: Comunicación de un caso

“…La evaluación radiológica del tórax es la base para la sospecha diagnóstica de una AI, así en series de adultos hasta 50% de los casos presentaban cavitación y 40% la formación de crescéntica aérea. Se señala que hay concordancia entre el tipo de hallazgo radiológico y la edad del paciente, siendo estos signos más frecuentes de observar en niños mayores y adultos [15][16][17] . El uso de TAC de tórax de alta resolución ha desplazado a la radiología convencional en el diagnóstico de aspergilosis pulmonar ya que permite la visualización de lesiones en forma más precoz y una mayor definición del tipo de lesiones mejorando francamente el rendimiento de la radiografía 18 .…”

Infections fongiques émergentes

“…Néanmoins, l'image radiologique peut être différente: cavités et nodules présents dans seulement 25% des cas sans aucun signe de formation de croissant gazeux [66] ou cavités et croissant gazeux observés seulement chez les enfants plus âgés [67] . L'aspergillose cutanée a été plus souvent rapportée chez les enfants que chez les adultes, en tant qu'infection soit localisée (incidence de 5 à 14%) soit disséminée [50,68] .…”

Invasive mycoses in children receiving hemopoietic SCT

“…2,3,18 Serial chest computed tomography is the method of choice for early detection of invasive pulmonary aspergillosis in neutropenic patients. [22][23][24][25][26] In these settings, the halosign represents the typical early computed tomography scan feature of invasive pulmonary mold infections. 26 In non-neutropenic subjects, the radiological features may be different, with the possible observation of aspecific nodules or even interstitial lesions.…”