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Weekly Chest CasesArchive of Old Cases

Case No : 1022 Date 2017-05-29

  • Courtesy of Da Jung Kim, Kiyeol Lee, Ji Young Choo / Korea University College of Medicine, Ansan Hospital
  • Age/Sex 35 / M
  • Chief Complaintneutropenic fever, underlying acute myeloid leukemia
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Invasive pulmonary aspergillosis
Radiologic Findings
Lung window setting of the contrast enhanced chest CT scan shows multifocal and bilateral variable-sized round areas of ground-glass attenuation surrounded by consolidative component (reversed halo sign). Serum galactomannan test was positive, and the patient showed improvement after treatment with voriconazole.
Brief Review
Aspergillosis is a serious pathologic condition caused by Aspergillus organism. It is frequently seen in immunocompromised patients, and angioinvasive aspergillosis is the most common form.
Characteristic CT findings in angioinvasive aspergillosis consist of nodules surrounded by a halo of ground-glass attenuation (halo sign) or pleura-based, wedge-shaped areas of consolidation. Although imaging findings in pulmonary aspergillosis may be nonspecific, in the appropriate clinical setting, familiarity with the CT findings may suggest or even help establish the diagnosis.
However, CT findings in angioinvasive aspergillosis can be variable and nonspecific, as was in this case. Reversed halo sign is an example. Although the reversed halo sign must be regarded as a nonspecific sign that can be encountered in many pulmonary conditions, in the context of immunosuppression, the reversed halo sign is highly suggestive of invasive fungal pneumonia, such as invasive aspergillosis or mucormycosis.
References
1. Franquet, Tomás, et al. Spectrum of Pulmonary Aspergillosis: Histologic, Clinical, and Radiologic Findings 1. Radiographics 21.4 (2001): 825-837.
2. Marchiori, Edson, et al. The reversed halo sign on high-resolution CT in infectious and noninfectious pulmonary diseases. American Journal of Roentgenology 197.1 (2011): W69-W75.
3. Wahba, Hisham, et al. Reversed halo sign in invasive pulmonary fungal infections. Clinical infectious diseases 46.11 (2008): 1733-1737.
Keywords
Lung, Invasive Pulmonary Aspergillosis,

No. of Applicants : 101

▶ Correct Answer : 38/101,  37.6%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - trichy kapv medical college , India arivudai nambi
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Chungbuk National University Hospital , Korea (South) SOOJUNG LEE
  • - consultant radiologist , India DEVINDERPAL SINGH DHANOTA
  • - Soonchunhyang University Hospital Seoul , Korea (South) SUNG HWAN BAE
  • - Chonnam National University Hospital , Korea (South) GUNSU KIM
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Other , Korea (South) SUNG HYUN YOON
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - , Korea (South) JAECHEON OH
  • - Chonnam National University Hospital, Radiology department , Korea (South) Park byung jin
  • - , India TEKWANI PARMANAND HOLARAM
  • - GHICL , France MANUEL TOLEDANO
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - , Korea (South) JEONGBIN PARK
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - Kilpauk Med college/GTHTM,tamilnadu , India SARAVANAN MANI
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Pusan national university hospital , Korea (South) Jin Joo Kim
  • - Pusan national university hospital , Korea (South) So min Park
▶ Correct Answer as Differential Diagnosis : 32/101,  31.7%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - NIMS, Hyderabad , India AMIT DADHANIA
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - Seoul National University Hospital , Korea (South) SU YEON AHN
  • - Other , Korea (South) SEONG SU KANG
  • - , India SANTOSH KUMAR PADHY
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - Samsung Medical Center , Korea (South) JUHYUN KIM
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Chonnam National University Hospital , Korea (South) YOUNSU AHN
  • - Myongji Hospital , Korea (South) JONG HYUK KIM
  • - Samsung medical center , Korea (South) Ran Kim
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Chonbuk National University Hospital , Korea (South) WON HYEONG IM
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - Other , Korea (South) HAYEON LEE
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - University of New South Wales , Australia RASHID HASHMI
  • - Other , Korea (South) DONGHWAN KIM
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - MCI , India TARUN KUMAR BAID
  • - Private sector , Greece VASILIOS TZILAS
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - University of Utah , United States AKIHIKO SAKATA
▶ Semi-Correct Answer : 15/101,  14.9%
  • - Pamukkale University, Faculty of Medicine, Dept. of Radiology , Turkey Furkan Ufuk
  • - Hospital Federico Abete , Argentina HO KYU LEE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Myongji Hospital , Korea (South) KYUNGHO KIM
  • - speciality medical officer , India DIVYESHKUMAR RAMNIKLAL DADHANIA
  • - Busan National University Hospital , Korea (South) LEE YOU JIN
  • - Amagasaki General Medical Center , Japan GENKI FUKUMOTO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - Yujin Yamazaki Hospital , Japan MASASHI TAKAHASHI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Chungbuk National University Hospital , Korea (South) HYEONMI RYU
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
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