The radiological spectrum of invasive aspergillosis in children: a 10-year review.
BACKGROUND
Invasive aspergillosis is an uncommon but life-threatening event in the immunocompromised child. Attempts at fungal isolation are often unrewarding and a high index of radiological suspicion is essential in the early diagnosis of infected children.


OBJECTIVE
To document the radiological spectrum of disease in invasive aspergillosis in the paediatric population.


METHODS
A retrospective review of the imaging performed in 27 consecutive patients (age 7 months to 18 years) with documented invasive Aspergillosis encountered over a 10-year period at a single institution.


RESULTS
Radiographic findings of pulmonary disease (20 patients) included segmental and multilobar consolidation, perihilar infiltrates, multiple small nodules, peripheral nodular masses and pleural effusions. No cavitating lesions were seen on CXR. Small cavitating nodules were present on CT in two of eight children. Chest wall disease was particularly associated with underlying chronic granulomatous disease. Disseminated disease manifested as osteomyelitis (n=5), cerebral (n=3), oesophageal (n=1), hepatic (n=2), renal (n=2) and cutaneous (n=5) involvement. Imaging findings are discussed. Twelve patients (44%) subsequently died from Aspergillus-related complications.


CONCLUSIONS
Invasive aspergillosis presents with a wide variety of radiographic findings involving multiple organ systems. Respiratory findings are varied but often non-specific, and a high index of suspicion is necessary in immunocompromised patients. In contrast to adult disease, the incidence of cavitation of pulmonary lesions appears low.
Department of Diagnostic Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, UK. karen.thomas@sickkids.ca
Karen E
KE
Thomas
Catherine M
CM
Owens
Paul A
PA
Veys
Vas
V
Novelli
Vera
V
Costoli
D000293:Adolescent; D001228:Aspergillosis / Q000000981:diagnostic imaging* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging* / Q000276:immunology; D008297:Male; D009894:Opportunistic Infections / Q000000981:diagnostic imaging* / Q000276:immunology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed