CT assessment of bone marrow transplant patients with rhinocerebral aspergillosis.
OBJECTIVE
Invasive rhinocerebral aspergillosis is a hazardous complication of bone marrow transplantation. A study was conducted to describe the computed tomography (CT) features of this disease.


METHODS
Charts and CT scans of bone marrow transplant patients with invasive rhinocerebral aspergillosis were reviewed. The diagnosis was confirmed by otolaryngologic examination and biopsy of suspected lesions. Sinus CT scans were conducted without contrast material. They were repeated with contrast if intracranial or intraorbital extension was suspected. CT scans were correlated with physical examination, history of disease, and histology.


RESULTS
Of 1,013 bone marrow transplantations carried out over a 10-year period, 21 patients (2.07%) developed invasive rhinocerebral aspergillosis. In most cases the infection was unilateral. Air-fluid levels and calcifications were rarely encountered. Mucosal thickening, soft tissue hyperdense masses in the nasal cavity and/or sinuses, and clear (uninvolved) ethmoid cells amid diseased cells, were significant CT features that characterized invasive fungal infection. Opacification of the sinus represented extensive disease with tissue necrosis. When bone destruction was encountered, fulminant infection was already present, usually with significant orbital and/or brain invasion.


CONCLUSIONS
When correlated with clinical findings and histologic results, the above CT features can help identify early infection so that appropriate medical and surgical treatment can be instituted.
Saah
Daniel
D
Departments of Otolaryngology/Head & Neck Surgery, Hadassah University Hospital, Jerusalem, Israel.
Sichel
Jean-Yves
JY
Schwartz
Allan
A
Nagler
Arnon
A
Eliashar
Ron
R
D000293:Adolescent; D000328:Adult; D001228:Aspergillosis / Q000000981:diagnostic imaging*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D001927:Brain Diseases / Q000000981:diagnostic imaging* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009668:Nose Diseases / Q000000981:diagnostic imaging* / Q000382:microbiology; D009894:Opportunistic Infections / Q000000981:diagnostic imaging* / Q000382:microbiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed