Radiological and clinical findings of 25 patients with invasive pulmonary aspergillosis: retrospective analysis of 2150 liver transplantation cases

Abstract

Objective: The purpose of this study was to evaluate the radiological and clinical findings of invasive pulmonary aspergillosis (IPA) after liver transplantation. Methods: This study included 25 consecutive liver transplant recipients with histologically confirmed IPA after liver transplantation. Radiological examinations performed for diagnosis were available in all patients. Clinical findings and changes in clinical response and radiological findings after treatment were also evaluated. Results: 3 main radiological findings were identified: nodules, 64% (16/25); masses, 36% (9/25); and consolidations in a patchy pattern, 20% (5/25). A tree-in-bud pattern was found in 12% (3/25) of patients. In 8 (32%) of 25 patients, we found a combination of 2 or more of these signs: 5 (20%) patients presented with concurrent nodules accompanied by patchy consolidations and/or tree-in-bud, and 3 (12%) patients showed masses accompanied by large consolidations. A halo sign was observed in 20 (80%) of 25 patients. Hypodense sign and cavitary lesions were encountered in 17 (68%) of 25 patients. Follow-up radiological findings after treatment showed improvement in 18 patients, no change in 4 patients and progression in 3 patients. There were three aspergillosis-associated deaths during the follow-up period. The onset time of IPA was a median of 31 days after transplantation. The most common symptom at diagnosis was fever (n=15). None of the 25 patients had leukopaenia at the time of the diagnosis of IPA. Conclusions: The most common radiological findings of IPA after liver transplantation are multiple nodules with or without halo sign, masses and consolidations, which usually appear about 1 month after transplantation.

Epidemiology, risk factors and outcomes of invasive aspergillosis in solid organ transplant recipients in the Swiss Transplant Cohort Study

“…Airway‐invasive radiographic patterns on chest CT of IA in SOTr have been previously reported . Angio‐invasive patterns, including nodular or necrotic lesions were observed in only half of the patients with an available CT in this series.…”

“…Airway-invasive radiographic patterns on chest CT of IA in SOTr have been previously reported. 16,17,36,37 Angio-invasive patterns, including nodular or necrotic lesions were observed in only half of the patients with an available CT in this series. In contrast, we observed that almost half of the patients with IA in this study had less specific chest CT findings, including pleural effusions and ground-glass opacities.…”

Pulmonary fungal infections in patients with acute myeloid leukaemia: is it the time to revise the radiological diagnostic criteria?

“…We think that appropriate microbiological evidence of a fungal aetiology in high‐risk patients may support the possibility to revise the current EORTC/MSG definitions extending the radiological suspicion of PFI to less traditional chest CT findings, including not well‐circumscribed consolidations, micronodules, ground glass opacities and other small airway lesions. The more specific radiological criteria considered in the EORTC/MSG definitions, eventually with the addition of the recently described ‘reversed halo sign’ and ‘hypodense sign’, should be probably preferred in clinical trials (i.e. primary or salvage antifungal therapy) where a high level of diagnostic accuracy is requested.…”

Aspergillus in Solid Organ and Stem Cell Transplant Patients: Emerging Options for Diagnosis and Management

“…A metaanalysis showed that the serum GM assay may have a greater utility in hematopoietic stem cell transplant recipients than in SOT recipients, in whom the sensitivity and specificity of the test were 22% and 84%, respectively [24]. Therefore, serum GM [19] Lung transplant [45] 64 proven or probable IPA: 53% nodular lesions, 47% non-nodular lesions, halo sign 3% Liver transplant [46] 25 patients proven IPA: 64% pulmonary nodules, 36% masses, 20% consolidations, 80% halo sign All types of sot recipients [47] 46 proven or probable IPA: consolidation or mass 72%, large nodules 59%, ground-glass opacity 50%…”