Angioinvasive pulmonary aspergillosis after allogeneic bone marrow transplantation: clinical and high-resolution computed tomography findings in 12 cases

Abstract

The aim of this study was to present the clinical and high-resolution CT scan findings of angioinvasive pulmonary aspergillosis (APA) in 12 patients who underwent allogeneic bone marrow transplantation (BMT). The CT scans were reviewed by three chest radiologists who assessed the pattern and distribution of findings by consent. There were 7 (58%) female and 5 (42%) male patients, with aging between 5 and 50 years (average of 26 years). All patients were submitted to BMT for the treatment of hematological conditions. The diagnosis of APA was defined between 5 and 373 days after BMT, with average of 111 days. Three cases (25%) were diagnosed in the neutropenic phase after the BMT, five (42%) in the early phase and four patients in the late phase post-BMT. Regarding high-resolution CT (HRCT) scan findings, nodules were found in 75% of the cases (9/12), most of the cases with more than 10 lesions (7/ 9) and of centrilobular localization (6/9). Consolidations were identified in seven patients (58%), being single in six, and commonly presenting ill defined borders (n=3) and subsegmental localization (n=5). Ground glass attenuation was found in six patients (50%). The halo sign was observed in nine cases (75%). Cavitations were seen in two airspace consolidations and one large nodule (2.5 cm). Patients submitted to BMT presenting respiratory symptoms and nodules or consolidations with halo sign at HRCT scan need to have the diagnosis of angioinvasive pulmonary aspergillosis included in all the post BMT phases.

Invasive aspergillosis in hematopoietic stem cell transplant recipients: a retrospective analysis

“…In our study, the halo sign was identified in 25% of the patients that had a CT scan (4/16). Gasparetto et al [14], in a review of 12 cases, identified the halo sign in 5 of 12 patients (41%); bilateral and asymmetric distribution of lesions was the dominant pattern (66%). When we compared the pediatric and adult groups, we did not find significant differences (p=0.63, chi-square test with Yates correction).…”

Pulmonary infections

“…16). In later stages, CT might show areas of necrotic tissue and pulmonary sequestration within the surrounding parenchyma, resulting in the air crescent sign [31].…”