[Invasive aspergillosis in the hematologic patient: the usefulness of computed tomographic and high-resolution computed tomographic studies].
Invasive aspergillosis is an emerging cause of death in hematologic patients. Several patterns of lung involvement are described: acute tracheobronchitis, bronchopneumonia, pleural aspergillosis and angioinvasive aspergillosis. The latter pattern is the most common one; it is characterized by different signs, some of which, supported by clinical data, are quite suggestive for fungal etiology. Particularly, nodules and/or wedge-shaped lesions with a ground-glass halo are a useful early feature, best detected by HRCT. Early therapy with amphotericin B may improve survival chances. Therefore, in neutropenia patients we decided, when possible, to perform high-resolution computed tomography (HRCT) as soon as fever appears. This was feasible in 8 of 32 patients with invasive aspergillosis examined with HRCT. Immediate treatment with amphotericin B in one such patient showing a nodule with the halo sign allowed the lesion to completely disappear. The authors describe the frequency of different radiologic signs in 32 patients, as observed in 54 HRCT exams; the results are compared with those obtained with conventional CT and chest X-ray. Compared to chest X-ray, CT detects more lesions and is more sensitive to small pneumothorax and minimal pleural effusion or thickening. HRCT is more suitable to detect initial cavitation and thin ground-glass haloes.
Sergiacomi
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Istituto di Radiologia, Università degli Studi Tor Vergata, Roma.
Tomiselli
A
A
Grimaldi
P
P
Gagliarducci
L
L
Cudillo
L
L
Rainaldi
A
A
Simonetti
G
G
D001228:Aspergillosis / Q000000981:diagnostic imaging*; D001996:Bronchopneumonia / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D006801:Humans; D007938:Leukemia / Q000150:complications* / Q000000981:diagnostic imaging; D008168:Lung / Q000000981:diagnostic imaging; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging*; D008223:Lymphoma / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*
Aspetti dell'aspergillosi invasiva nel paziente ematologico: utilità dello studio mediante Tomografia Computerizzata e Tomografia Computerizzata ad alta risoluzione.