Fungal pulmonary infections after bone marrow transplantation: evaluation with radiography and CT.

Abstract

The authors reviewed 55 pairs of chest radiographs and computed tomographic (CT) studies obtained in 33 febrile bone marrow transplant (BMT) recipients. The images were read separately, without knowledge of the clinical diagnosis. Twenty-one episodes of fungal infection were documented. One chest radiograph showed a pneumonia-like opacity, and 17 showed nodular opacities, five with cavitation. In 20 of 21 episodes, CT showed nodules with cavitation (n = 7), halo (n = 4), hazy margin (n = 5), air bronchogram (n = 2), cluster of fluffy nodules (n = 1), or sharp margin (n = 1). In none of the nine bacteremic episodes, however, were there opacities on chest radiographs or CT studies. CT studies demonstrating complicated nodules in febrile BMT patients strongly suggest a fungal infection, whereas negative CT studies suggest bacteremia or non-filamentous fungal infection of nonpulmonary origin. CT appears to add useful information to radiographic analysis during the assessment of febrile episodes in BMT patients, especially when invasive diagnostic procedures pose a high risk.

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

“…In this early phase, the histopathological examination demonstrates focus of ischemic lung originating nodules of 1 to 3 cm with central necrosis and hyphae, and surrounding hemorrhage [15,17,19]. This histological finding is demonstrated in the HRCT scan as the halo sign, which was seen in 75% of our cases.…”

“…The HRCT scan is superior to plain radiographic films in the detection and characterization of pulmonary complications after BMT. This exam is indicated in the presence of clinical manifestations of pulmonary disease with normal or unspecific radiographic findings, and for those patients who do not present clinical improvement despite adequate therapy [9,[14][15][16][17]. Therefore, the HRCT scan allows more effective investigation for patients in the period after BMT, which is of high importance in such patients whose clinical deterioration is fast and lethal.…”

“…Cavitations are usually a late finding in patients with APA, and represent the resolution phase of the infection [5,15,20]. These findings are seen due to the presence of granulocytes, generally 3-4 days after leukocyte count achieve more than 1,000/mm 3 .…”

Tomografia computadorizada na avaliação da aspergilose pulmonar angioinvasiva em pacientes com leucemia aguda

“…On the other hand, Mori et al (18) and Won et al (19) have found this sign respectively in only 19% and 40% of cases. No cavitation was found in any case, differently from the findings of Kuhlman et al (11) , where cavitation was observed in five of seven cases (71.4%).…”

“…There are studies demonstrating that about 50% of neutropenic patients undergoing treatment with chemotherapy, or submitted to bone marrow transplantation, present severe fungal infection at some phase of their evolution (16,18) .…”