Chest computed tomography of late invasive aspergillosis after allogeneic hematopoietic stem cell transplantation

Biol Blood Marrow Transplant. 2005 Jul;11(7):506-11. doi: 10.1016/j.bbmt.2005.03.005.

Abstract

Computed tomography (CT) is a powerful diagnostic tool for invasive aspergillosis (IA) after allogeneic stem cell transplantation (allo-SCT); however, little information is available concerning CT findings of late IA after allo-SCT. To characterize CT findings of late IA, we retrospectively examined medical records and high-resolution CT findings of 27 allo-SCT recipients with late IA. Either acute or chronic GVHD was diagnosed in 24 patients. All 27 patients were given corticosteroids at IA diagnosis. High-resolution CT findings included halo (n=12), centrilobular nodules (n=12), ill-defined consolidation (n=13), ground-glass attenuation (n=8), pleural effusion (n=7), pleural-based consolidation (n=4), and cavitation (n=4). CT findings showing centrilobular nodules and either halo or cavitation were classified into bronchopneumonia type and angioinvasive type, respectively. Angioinvasive-type, bronchopneumonia-type, and combination-type IA were diagnosed in 11, 8, and 4 patients, respectively. CT findings were nonspecific in the other 4 patients. One bronchopneumonia-type case and 2 angioinvasive-type IA cases were subsequently diagnosed as combination type. Although there were no significant differences in patient characteristics between the 2 types of IA, bronchopneumonia-type IA had a poorer prognosis than angioinvasive IA ( P=.022). Halo is a useful diagnostic marker in late IA as well as early IA, and late IA frequently manifests as bronchopneumonia.

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Adult
  • Aged
  • Aspergillosis / diagnostic imaging*
  • Aspergillosis / pathology
  • Bronchopneumonia / diagnostic imaging*
  • Bronchopneumonia / microbiology
  • Bronchopneumonia / pathology
  • Female
  • Graft vs Host Disease / microbiology
  • Graft vs Host Disease / prevention & control
  • Hematologic Neoplasms / therapy
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Lung Diseases, Fungal / diagnostic imaging*
  • Lung Diseases, Fungal / microbiology
  • Lung Diseases, Fungal / pathology
  • Male
  • Middle Aged
  • Opportunistic Infections / diagnostic imaging*
  • Opportunistic Infections / microbiology
  • Opportunistic Infections / pathology
  • Thorax / microbiology
  • Tomography, X-Ray Computed
  • Transplantation, Homologous

Substances

  • Adrenal Cortex Hormones