Early chest radiography and CT in the diagnosis, management and outcome of invasive pulmonary aspergillosis.
OBJECTIVE
We report the chest radiographic and CT findings in 21 immunocompromised patients with invasive pulmonary aspergillosis (IPA) and describe the outcome when the early diagnosis was linked to treatment with liposomal amphotericin B.


METHODS
Chest radiographs and CT examinations were analyzed retrospectively in 53 consecutive neutropenic patients with suspected early IPA.


RESULTS
Twenty-one of 244 patients admitted for chemotherapy of hematologic malignancy fulfilled the definition for IPA - incidence of 8.6%. The incidence of normal and non-specific chest radiographic findings was high (29% and 71%, respectively) during the early stages of IPA. The CT halo sign was seen in 20 of the 21 patients (95%), and occurred within 5 days of neutropenic fever that was unresponsive to antibiotics in 5 patients. Crescent signs or cavitations were seen in 7 patients (33%). Treatment with liposomal amphotericin B was associated with an attributable mortality of 9.5%. Two patients died from IPA having a high fungal burden.


CONCLUSIONS
Early chest CT in neutropenic patients at risk for IPA is an important diagnostic and management tool and should be included in the investigative protocol even when chest radiographs are normal or non-specific.
Hauggaard
A
A
Department of Radiology, Tawam Hospital, Al Ain, Abu Dhabi, UAE.
Ellis
M
M
Ekelund
L
L
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000000981:diagnostic imaging* / Q000188:drug therapy; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007938:Leukemia / Q000150:complications / Q000188:drug therapy; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D008081:Liposomes; D000666:Amphotericin B