Discussion
Diagnosis With Brief Discussion
- Diagnosis
- COVID-19 associated pulmonary aspergillosis (CAPA)
- Radiologic Findings
- Figure 1. Initial chest radiograph shows ground-glass opacity (GGO) and consolidation, predominantly in peripheral lungs.
Figure 2, 3. Initial axial and coronal chest CT images show patchy GGO and consolidation predominantly in peripheral lungs, suggesting COVID-19 pneumonia.
Figure 4. Chest radiograph obtained 3 weeks later shows the appearance of a cavity in the right lung field.
Figure 5, 6. Axial chest CT images obtained 3 weeks later demonstrate a large cavity in the RUL. COVID-19 pneumonia in the peripheral lung shows interval improvement.
- Brief Review
- Pulmonary aspergillosis is emerging as a serious secondary infection in patients with COVID-19 and ARDS, and two studies have indicated excess mortality rates of 16% and 25% compared with patients without evidence for aspergillosis. However, it is unclear whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection itself is the main risk factor for CAPA, or whether additional risk factors, such as corticosteroid therapy, further increase the risk for disease progression.
The typical appearance of COVID-19 in patients includes peripheral, bilateral, ground-glass opacities with or without consolidation or visible intralobular lines (ie, so-called crazy paving) in early stages; multifocal ground-glass opacities of rounded morphology with or without consolidation or visible intralobular lines (ie, crazy paving) at peak stage; and reverse halo sign or other findings of organizing pneumonia at late stages.
Imaging findings of multiple pulmonary nodules or lung cavitation should prompt thorough investigation for pulmonary aspergillosis, as they are rarely seen with COVID-19 alone and have been described in a patients with CAPA.
- References
- Koehler P, Bassetti M, Chakrabarti A et al. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis. 2021 Jun;21(6):e149-e162
- Keywords
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