Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Angioinvasive and Airway-invasive Aspergillosis
- Radiologic Findings
- Chest radiogram (Fig. 1) and chest CT (Fig. 2) show a cavitary lesion with air-fluid level, mottled air densities, and air bronchogram in apical segment of RUL with surrounding halo ground glass attenuation. Also multiple peribronchovascular consolidations and ill-defined centrilobular nodules with branching linear opacities is noted in BULs, RML and RLL.
Follow up radiogram (Fig. 3) and chest CT lung window setting (Fig. 4) after 2 weeks show aggravated peribronchial consolidations and GGOs with air-bronchogram associated with cavitary lesion in RUL.
Bronchoscopic biopsy was done and pathologic diagnosis was invasive aspergillosis. The diagnosis is angioinvasive aspergillosis combined with airway invasive aspergillosis.
- Brief Review
- Aspergillus infection may manifest in clinically and radiologically distinct patterns: aspergilloma, allergic bronchopulmonary aspergillosis, semi-invasive aspergillosis, airway invasive aspergillosis, and angioinvasive aspergillosis. 60% of fungal pneumonias in immunocompromised patients are caused by Aspergillus. Aspergillus infection may also occur in normal host following massive inhalation, known as primary aspergillosis.
Angioinvasive aspergiollosis is caused by hyphal invasion of blood vessels resulting in infarction and necrosis. Clinically, it is characterized by a hemorrhagic bronchopneumonia with fever, cough, dyspnea, and chest pain. CT typically shows nodules or masses may be surrounded by a halo of ground glass attenuation (CT halo sign). The halo sign is caused by hemorrhage surrounding the nodule or mass of necrotic fungal infected lung tissue. After 2~3 weeks, crescentic and eventual circumferential cavitation may be seen (air crescent sign). It may evolve to aspergilloma.
Airway-invasive aspergillosis is less common than angioinvasive aspergillosis. It is characterized by the presence of Aspergillus deep to the airway basement membrane. It causes a spectrum of diseases, including acute tracheobronchitis, bronchiolitis, and bronchopneumonia. Centrilobular nodules, tree-in-bud opacities, and peribronchial consolidations can be seen at HRCT. Invasive tracheobronchial aspergillosis is associated with ulcerations of trachea and central bronchi, and can cause atelectasis and consolidation.
- References
- 1. Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign. Greene RE, et al. Clin Infect Dis. 44(3):373-9, 2007
- Keywords
- Lung, Infection, Fungal infection,