title: Radiological and clinical findings of 25 patients with invasive pulmonary aspergillosis: retrospective analysis of 2150 liver transplantation cases.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the radiological and clinical findings of invasive pulmonary aspergillosis (IPA) after liver transplantation.
  
  
  METHODS
  This study included 25 consecutive liver transplant recipients with histologically confirmed IPA after liver transplantation. Radiological examinations performed for diagnosis were available in all patients. Clinical findings and changes in clinical response and radiological findings after treatment were also evaluated.
  
  
  RESULTS
  3 main radiological findings were identified: nodules, 64% (16/25); masses, 36% (9/25); and consolidations in a patchy pattern, 20% (5/25). A tree-in-bud pattern was found in 12% (3/25) of patients. In 8 (32%) of 25 patients, we found a combination of 2 or more of these signs: 5 (20%) patients presented with concurrent nodules accompanied by patchy consolidations and/or tree-in-bud, and 3 (12%) patients showed masses accompanied by large consolidations. A halo sign was observed in 20 (80%) of 25 patients. Hypodense sign and cavitary lesions were encountered in 17 (68%) of 25 patients. Follow-up radiological findings after treatment showed improvement in 18 patients, no change in 4 patients and progression in 3 patients. There were three aspergillosis-associated deaths during the follow-up period. The onset time of IPA was a median of 31 days after transplantation. The most common symptom at diagnosis was fever (n=15). None of the 25 patients had leukopaenia at the time of the diagnosis of IPA.
  
  
  CONCLUSIONS
  The most common radiological findings of IPA after liver transplantation are multiple nodules with or without halo sign, masses and consolidations, which usually appear about 1 month after transplantation.
authors.affiliation: Department of Radiology/Institute of Interventional Radiology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: J
authors.initials: J
authors.lastname: Qin
authors.forename: Y
authors.initials: Y
authors.lastname: Fang
authors.forename: Y
authors.initials: Y
authors.lastname: Dong
authors.forename: K
authors.initials: K
authors.lastname: Zhu
authors.forename: B
authors.initials: B
authors.lastname: Wu
authors.forename: Y
authors.initials: Y
authors.lastname: An
authors.forename: H
authors.initials: H
authors.lastname: Shan
mesh_terms: D000328:Adult; D000368:Aged; D032921:Consensus; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D055744:Invasive Pulmonary Aspergillosis / Q000150:complications / Q000000981:diagnostic imaging*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging; D009894:Opportunistic Infections / Q000150:complications / Q000000981:diagnostic imaging*; D011379:Prognosis; D012189:Retrospective Studies; D016559:Tacrolimus / Q000009:adverse effects
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus