Invasive pulmonary aspergillosis: prediction at thin-section CT in patients with neutropenia--a prospective study.

Won, Hyung Jin; Lee, Kyung Soo; Cheon, Jung Hee; Hwang, Jung Hwa; Kim, Tae Sung; Lee, Hong Ghi; Han, Joungho

doi:10.1148/radiology.208.3.9722859

Cited by 100 publications

(65 citation statements)

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“…Consolidations were predominantly peripheral in 83.3% in this casuistic, while in the great majority of studies in the literature these percentages have reached approximately 100%. In our study, consolidations were multiple in 66.6% of cases which is in agreement with authors like Kuhlman et al (11) and Won et al (19) .…”

Section: Discussionsupporting

confidence: 93%

“…The halo sign in consolidations was found in nine of our 12 cases (75%), which coincides with the findings of Won et al (19) , where this percentage was 81%. Cavitation was observed in just six of our 12 cases (50%), with air crescent sign in only two of them.…”

Section: Discussionsupporting

confidence: 92%

“…Won et al (19) have found consolidation in 80% of leukemic patients with angioinvasive pulmonary aspergillosis, such consolidations being associated with nodules in 20% of the cases, a data that is similar to those found in this study, where consolidations occurred in 12 of 19 cases (63%), and associated with nodules in 25% of cases. Consolidations were predominantly peripheral in 83.3% in this casuistic, while in the great majority of studies in the literature these percentages have reached approximately 100%.…”

Section: Discussionsupporting

confidence: 90%

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

Leão¹,

Marchiori

Rodrigues

et al. 2006

Radiol Bras

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OBJECTIVE: The aim of this study was to evaluate the main findings of computed tomography in patients presenting acute leukemia complicated by angioinvasive aspergillosis. MATERIALS AND METHODS: Computed tomography images of 19 patients were retrospectively studied for the presence of consolidations, nodules and masses, with or without presentation of halo sign, cavitation and air crescent sign. RESULTS: Consolidation was the most frequent finding, occurring in 12 of the 19 cases, most of them presenting the halo sign; cavitation was found in 5 of 12 cases, one of them with air crescent sign. Nodules and masses occurred respectively in six and four cases, most of them with halo sign. Cavitation was found in only one case of mass. Other findings observed were: crazy-paving pattern (two cases), patchy areas of ground-glass attenuation opacity (three cases) and pleural involvement (seven cases) under the form of effusion or thickening. CONCLUSION: Areas of consolidation, mass or nodule, even a solitary one, presenting halo sign on CT images evaluated in an appropriate clinical context are highly suggestive of angioinvasive aspergillosis. Keywords: Angioinvasive pulmonary aspergillosis; Acute leukemia; Computed tomography.Tomografia computadorizada na avaliação da aspergilose pulmonar angioinvasiva em pacientes com leucemia aguda. OBJETIVO: O objetivo deste trabalho foi avaliar os principais achados na tomografia computadorizada de pacientes portadores de leucemia aguda complicada com aspergilose pulmonar angioinvasiva. MATERIAIS E MÉ-TODOS: Foram estudadas, retrospectivamente, tomografias computadorizadas de 19 pacientes, avaliando-se a presença de consolidações, nódulos e massas, com ou sem sinal do halo, escavação e sinal do crescente aéreo. RESULTADOS: Áreas de consolidação foram o achado mais comum, ocorrendo em 12 dos 19 casos. A maioria delas apresentou o sinal do halo, enquanto escavação foi encontrada em 5 dos 12 casos com consolidações, sendo um deles com sinal do crescente aéreo. Nódulos e massas ocorreram em, respectivamente, seis e quatro casos, a maioria com sinal do halo. Escavação foi encontrada em apenas um caso de massa. Outros achados observados foram pavimentação em mosaico (dois casos), áreas de vidro fosco esparsas (três casos) e envolvimento pleural (sete casos), sob a forma de derrame ou espessamento. CONCLUSÃO: Áreas de consolidação, massas ou nódulo, mesmo solitário, com sinal do halo, quando vistos na tomografia computadorizada em um contexto clínico apropriado, são altamente sugestivos de aspergilose angioinvasiva. Unitermos: Aspergilose pulmonar angioinvasiva; Leucemia aguda; Tomografia computadorizada. AbstractResumo

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

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

Leão¹,

Marchiori

Rodrigues

et al. 2006

Radiol Bras

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“…CT of the chest has been advocated for the early diagnosis of IPA as it often shows a 'halo sign' in the early phase of the disease in neutropenic patients with IPA (Caillot et al, 1997(Caillot et al, , 2001Denning et al, 1997). However, the halo sign is not specific for IPA as it is also seen in a number of other entities, including mucormycosis, organizing pneumonia and pulmonary haemorrhage (Won et al, 1998). The 'aircrescent sign' and other signs of cavitations are highly suggestive for invasive pulmonary fungal infection, but they often appear in a late stage of the disease, after bone marrow recovery.…”

mentioning

confidence: 99%

Galactomannan detection in computerized tomography‐based broncho‐alveolar lavage fluid and serum in haematological patients at risk for invasive pulmonary aspergillosis

Becker¹,

Lugtenburg²,

Cornelissen³

et al. 2003

Br J Haematol

189

123

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Summary. We determined the value of galactomannan (GM) detection in computerized tomography (CT)-based broncho-alveolar lavage (BAL) fluid and serum for the diagnosis of invasive pulmonary aspergillosis (IPA) in haemato-oncological patients with neutropenia. CT of the thorax and BAL were performed systematically at predefined clinical indications. GM was determined by sandwich enzyme-linked immunosorbent assay; the clinicians were unaware of the results. Of 160 patients, 17 patients (10AE6%) presented with proven, probable or suspected IPA. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of GM detection in CT-based BAL fluid were all 100%. For GM detection in serially sampled serum, the sensitivity was 47%, the specificity 93%, the PPV 73% and the NPV 82%. A non-blinded follow-up study was performed to validate these results. In this study, 22 of 198 patients (11AE1%) presented with IPA, and the sensitivity, specificity, PPV and NPV of GM detection in CT-based BAL fluid were 85%, 100%, 100% and 88% respectively. None of BAL fluids obtained after antifungal treatment of 3 d or more were positive. These results indicate that, when CT is used systematically and at an early stage, GM detection in CT-based BAL fluid has a high PPV for diagnosing IPA early in untreated patients.

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“…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 .…”

Section: Discussionmentioning

confidence: 99%

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

Gasparetto¹,

Souza²,

Tazoniero³

et al. 2007

Braz J Infect Dis

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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.

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Invasive pulmonary aspergillosis: prediction at thin-section CT in patients with neutropenia--a prospective study.

Cited by 100 publications

References 0 publications

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

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

Galactomannan detection in computerized tomography‐based broncho‐alveolar lavage fluid and serum in haematological patients at risk for invasive pulmonary aspergillosis

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

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