High Resolution Computed Tomography Angiography Improves the Radiographic Diagnosis of Invasive Mold Disease in Patients With Hematological Malignancies

Stanzani, Marta; Sassi, Claudia; Lewis, Russell E.; Tolomelli, Giulia; Bazzocchi, Alberto; Cavo, Michèle; Vianelli, Nicola; Battista, Giuseppe

doi:10.1093/cid/civ154

Cited by 83 publications

(72 citation statements)

References 23 publications

(35 reference statements)

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“…Of interest, all the four patients submitted to CTPA for macronodular consolidations revealed no evidence of angioinvasion at initial clinical presentation. This lack of angioinvasion contrasts with our control group with proven IA or mucormycosis in whom CTPA showed vessel occlusion (100% of readable cases) (Fig. ).…”

Section: Discussioncontrasting

confidence: 68%

“…High‐resolution computed tomography (HRCT) of pulmonary IMD could reveal indirect signs of angioinvasion (halo sign, air crescent sign). Recently, computed tomography pulmonary angiography (CTPA) showed to be more sensitive and possibly specific tool for detection of angioinvasion . The reversed‐halo sign is highly suggestive for mucormycosis, but no further radiological findings can discriminate between infections sustained by different moulds.…”

Section: Introductionmentioning

confidence: 99%

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Radiologic findings of Fusarium pneumonia in neutropenic patients

Sassi

Stanzani

Lewis

et al. 2016

Mycoses

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In neutropenic patients, lungs are involved in 50%-80% of cases of fusariosis, but imaging of pulmonary fusariosis has been previously described as indistinguishable from other invasive mould diseases. Our attempt was to identify a radiological pattern that may distinguish pulmonary fusariosis from other mould diseases. We examined the CT findings of nine neutropenic haematology patients with invasive fusariosis. As control group for comparison, we examined 14 invasive mould diseases (11 aspergillosis, 3 mucormycosis) in haematology patients with similar underlying disease and timing of CT imaging. Chest-CT in invasive fusariosis showed small airways (7/9) or peribronchial (5/9) infiltrates, less frequently macronodular consolidations (4/9) with hypodense sign, but without halo sign or occluded-vessel sign. The control group presented macronodular consolidations with occluded-vessel sign in all of the cases; the halo and the hypodense signs were observed, respectively, in 100% and 82% of aspergillosis, and in 67% and 100% of mucormycosis. Sinusitis was documented by CT in 7/7 fusariosis, 2/2 mucormycosis and 5/7 aspergillosis; maxillary and ethmoid sinuses were involved in 7/7 fusariosis, in most of the cases with hyperdense opacification (rarely observed in the controls). We concluded that no radiological findings can discriminate between different mould infections, but invasive fusariosis should be suspected if chest-CT demonstrates pulmonary infiltrates with the hypodense sign, but without the halo or the occluded-vessel signs. Suspicion is greater in the presence of hyperdense maxillary and ethmoid sinusitis.

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Section: Discussioncontrasting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Radiologic findings of Fusarium pneumonia in neutropenic patients

Sassi

Stanzani

Lewis

et al. 2016

Mycoses

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“…It has been suggested that CT angiography may be more sensitive than conventional CT in detecting fungal pneumonia in HM/HSCT patients 60 , but is not standard practice. FDG-PET/CT cannot reliably differentiate malignancy from infectious pulmonary nodules.…”

Section: Diagnosis Of Hm/hsct Fungal Pneumioniamentioning

confidence: 99%

Fungal Pneumonia in Patients with Hematologic Malignancy and Hematopoietic Stem Cell Transplantation

Young¹,

Juarez

Evans

2017

Clinics in Chest Medicine

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Synopsis Fungal pneumonias cause unacceptable morbidity among patients with hematologic malignancies (HM) and recipients of hematopoietic stem cell transplantation (HSCT). The high incidence of fungal pneumonias in HM/HSCT populations arises from their frequently severe, complex and persistent immune dysfunction caused by both the underlying disease and its treatment. The cytopenias, treatment toxicities and other immune derangements that make HM/HSCT patients susceptible to fungal pneumonia frequently also complicate its diagnosis by impeding generation of classically recognizable host response patterns and increase the intensity and duration of required antifungal therapy. This manuscript addresses the host factors that contribute to susceptibility, summarizes diagnostic recommendations, and reviews current guidelines for management of fungal pneumonia in HM/HSCT patients.

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“…The diagnosis of invasive fusariosis is based on the growth of the fungus in blood culture or from deep tissue biopsy. More recently, radiological features have been proposed that may help distinguish sinopulmonary infections caused by Fusarium from more common moulds such as Aspergillus . The management of invasive fusariosis is complicated by intrinsic resistance of Fusarium species to many classes of antifungal agents.…”

Section: Introductionmentioning

confidence: 99%

Successful treatment of bilateral endogenous Fusarium solani endophthalmitis in a patient with acute lymphocytic leukaemia

Rizzello

Castagnetti

Toschi

et al. 2017

Mycoses

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High Resolution Computed Tomography Angiography Improves the Radiographic Diagnosis of Invasive Mold Disease in Patients With Hematological Malignancies

Abstract: Vessel occlusion detected by CTPA is a more sensitive and possibly more specific radiographic sign vs other common CT findings of invasive mold disease in patients with hematological malignancies.

Cited by 83 publications

References 23 publications

Radiologic findings of Fusarium pneumonia in neutropenic patients

Radiologic findings of Fusarium pneumonia in neutropenic patients

Fungal Pneumonia in Patients with Hematologic Malignancy and Hematopoietic Stem Cell Transplantation

Successful treatment of bilateral endogenous Fusarium solani endophthalmitis in a patient with acute lymphocytic leukaemia

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