Invasive pulmonary aspergillosis and acute leukemia. Limitations in the diagnostic utility of the air crescent sign.

Gefter, Warren B.; Albelda, Steve M.; Talbot, George H.; Gerson, Stanton L.; Cassileth, Peter A.; Miller, Wallace T.

doi:10.1148/radiology.157.3.4059547

Cited by 106 publications

(47 citation statements)

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“…10,11 The development of cavitary lesions has been associated with a rapid rise in neutrophil count following a neutropenic episode. 12,13 This pathogenesis is consistent with the clinical findings in this case. Although neutropenia was not documented it could be postulated that the foal was neutropenic at the onset of acute enteritis with subsequent neutrophilia confirmed.…”

supporting

confidence: 91%

Successful Treatment of Invasive Pulmonary Aspergillosis in a Neonatal Foal

Hilton

Galuppo

Puchalski

et al. 2009

Veterinary Internal Medicne

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A 55 kg, 14-day-old, Thoroughbred colt foal was examined because of acute respiratory distress of 4 hours duration. The colt had been born at 320 days gestation and parturition was normal. Serum IgG 48 hours after birth was 4800 mg/dL. a The colt was hospitalized for treatment of diarrhea 7 days after birth; acidemia (pH 7.247; reference range 7.32-7.44), hyponatremia (108 mEq/L; reference range 132-146 mEq/L), hypo-chloremia (89 mEq/L; reference range 99-109 mEq/L), and leukocytosis (22,500 cells/mL; reference range 5,300-14,000 cells/mL) due to neutrophilia (18,913 neutrophils/ mL; reference range 3,400-11,900 neutrophils/mL) were documented. Thoracic radiography performed during hospitalization identified a thin-walled gas-filled structure within the right caudo-dorsal lung field and increased soft-tissue opacity consistent with regional pulmonary consolidation (Fig 1). The radiographic diagnosis was congenital pulmonary bulla. The foal responded to IV administration of fluids and antibiotic therapy but a CBC identified continued leukocytosis on days 2 and 4 of hospitalization (19,690 and 23,650 cells/ mL, respectively). The foal was discharged from the hospital with a recommendation for administration of ceftiofur sodium (10 mg/kg SQ q12h for 14 days) and amikacin (21 mg/kg IM q24h for 7 days). The foal presented for examination 24 hours after discharge with signs of respiratory distress including marked abdominal effort and nostril flare. Heart rate was 120 bpm, respiratory rate 60 bpm, and rectal temperature 100.11F. Mucous membranes were pale and cyanotic. Thoracic auscultation identified reduced bronchovesicular sounds bilaterally. Thoracic ultrasono-graphy and radiography identified free gas and pulmonary collapse within the right and left pleural cavities consistent with bilateral pneumothorax. The previously identified pulmonary bulla in the right ca-udo-dorsal lung field appeared attached to the dorsal parietal pleura (Fig 2). Bilateral thoracocentesis and aspiration of pleural gas relieved respiratory distress. Thoracic radiographs performed after thoracocentesis revealed bilateral inflation of the lungs with minimal residual free air within the thoracic cavity. A CBC identified anemia (28.3%; reference range 30-46%), leukocytosis (34,640 cells/mL) because of neutrophilia (32,562 cells/mL) and hyperfibrinogenemia (600 mg/dL; reference range 100-400 mg/dL). Serum biochemistry identified hyperglycemia (304 mg/dL; reference range 122-205 mg/dL), venous blood gas analysis indicated acidemia (pH 7.219) with both respiratory and metabolic components (PvCO 2 70.5 mmHg; reference range 40-50 mmHg, lactate 2.1 mmol/L; reference range 0-2 mmol/L). A diagnosis of bilateral pneumothorax secondary to rupture of the pulmonary bulla was suspected based on the clinical presentation, diagnostic imaging findings, and previous identification of the pulmonary bulla. Within 1 hour of the initial stabilization, the foal was again noted to be in respiratory distress. A 2nd thor-acocentesis was performed and an indwelling ...

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supporting

confidence: 91%

Successful Treatment of Invasive Pulmonary Aspergillosis in a Neonatal Foal

Hilton

Galuppo

Puchalski

et al. 2009

Veterinary Internal Medicne

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“…Specifically, the presence of a "halo sign," defined as a nodule surrounded by a zone of ground-glass attenuation, is reasonably sensitive (70 to 80%) and specific (60 to 98%) for invasive aspergillosis in high-risk patients (26,156,292,308). Cavitation generally occurs later in the course of the disease (1 to 2 weeks after the appearance of the halo sign) and is often noted during recovery from neutropenia in previously neutropenic patients (83,122,201). The onset of cavitation is heralded by the so-called "air crescent sign," defined as crescents of air surrounding nodular lesions; further necrosis due to fungal angioinvasion and resultant ischemia results in progressive cavity formation in up to 63% of patients (4,26,156,292).…”

Section: Fungal Infectionsmentioning

confidence: 99%

Cavitary Pulmonary Disease

2008

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SUMMARY A pulmonary cavity is a gas-filled area of the lung in the center of a nodule or area of consolidation and may be clinically observed by use of plain chest radiography or computed tomography. Cavities are present in a wide variety of infectious and noninfectious processes. This review discusses the differential diagnosis of pathological processes associated with lung cavities, focusing on infections associated with lung cavities. The goal is to provide the clinician and clinical microbiologist with an overview of the diseases most commonly associated with lung cavities, with attention to the epidemiology and clinical characteristics of the host.

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“…The latter may be found with mycetomas, cavitary tuberculosis and even invasive aspergillosis; all diagnostic considerations in this case [2,3]. The contents of the air crescent cavity appear gravity-dependent on the lateral decubitus or prone radiograph and CT scan [1,2].…”

Section: Discussionmentioning

confidence: 76%