title: Radiologic findings of Fusarium pneumonia in neutropenic patients.
abstract: In neutropenic patients, lungs are involved in 50%-80% of cases of fusariosis, but imaging of pulmonary fusariosis has been previously described as indistinguishable from other invasive mould diseases. Our attempt was to identify a radiological pattern that may distinguish pulmonary fusariosis from other mould diseases. We examined the CT findings of nine neutropenic haematology patients with invasive fusariosis. As control group for comparison, we examined 14 invasive mould diseases (11 aspergillosis, 3 mucormycosis) in haematology patients with similar underlying disease and timing of CT imaging. Chest-CT in invasive fusariosis showed small airways (7/9) or peribronchial (5/9) infiltrates, less frequently macronodular consolidations (4/9) with hypodense sign, but without halo sign or occluded-vessel sign. The control group presented macronodular consolidations with occluded-vessel sign in all of the cases; the halo and the hypodense signs were observed, respectively, in 100% and 82% of aspergillosis, and in 67% and 100% of mucormycosis. Sinusitis was documented by CT in 7/7 fusariosis, 2/2 mucormycosis and 5/7 aspergillosis; maxillary and ethmoid sinuses were involved in 7/7 fusariosis, in most of the cases with hyperdense opacification (rarely observed in the controls). We concluded that no radiological findings can discriminate between different mould infections, but invasive fusariosis should be suspected if chest-CT demonstrates pulmonary infiltrates with the hypodense sign, but without the halo or the occluded-vessel signs. Suspicion is greater in the presence of hyperdense maxillary and ethmoid sinusitis.
authors.affiliation: Division of Radiology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Claudia
authors.identifier: http://orcid.org/0000-0002-7864-2586
authors.initials: C
authors.lastname: Sassi
authors.affiliation: Department of Hematology and Oncology, Institute of Hematology "Lorenzo e Ariosto Seràgnoli", S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Stanzani
authors.affiliation: Department of Internal Medicine Geriatrics and Nephrologic Diseases (DIMEC), Clinic of Infectious Diseases, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Russell E
authors.identifier: http://orcid.org/0000-0002-2002-4339
authors.initials: RE
authors.lastname: Lewis
authors.affiliation: Department of Hematology and Oncology, Institute of Hematology "Lorenzo e Ariosto Seràgnoli", S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Vianelli
authors.affiliation: Division of Radiology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tarsi
authors.affiliation: Division of Radiology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Poerio
authors.affiliation: Department of Hematology and Oncology, Institute of Hematology "Lorenzo e Ariosto Seràgnoli", S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Cavo
authors.affiliation: Division of Radiology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giuseppe
authors.identifier: http://orcid.org/0000-0003-3639-3494
authors.initials: G
authors.lastname: Battista
mesh_terms: D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D060585:Fusariosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000382:microbiology; D005670:Fusarium / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D000072742:Invasive Fungal Infections / Q000000981:diagnostic imaging; D008168:Lung / Q000382:microbiology; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000175:diagnosis; D009503:Neutropenia / Q000150:complications; D011014:Pneumonia / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000382:microbiology; D014057:Tomography, X-Ray Computed
keywords: CT-computed tomography; fusariosis; immunodepression; opportunistic pneumonia