[Invasive pulmonary aspergillosis: possibility of radiologic diagnosis]

The incidence of invasive pulmonary aspergillosis is increasing in the patients with malignant hematologic diseases; this occurs in the phase of granulocytopenia induced by chemotherapy. In these cases an early diagnosis is mandatory to start a prompt antimycotic treatment. The authors reviewed the personal series of 56 patients with malignant hematologic diseases who, in the phase of granulocytopenia, developed a pulmonary lesion: 32/56 with invasive pulmonary aspergillosis; 8/56 with Candida and 16/56 with bacterial infection. All patients underwent several conventional radiologic controls: 9 cases with invasive pulmonary aspergillosis were also studied with Computed Tomography (CT). After a short pathologic introduction, the conventional radiologic and CT patterns of invasive pulmonary aspergillosis are analyzed, both at onset and over its evolutive phase. The most significant feature for an early conventional radiologic diagnosis is the nodular pattern--single or multiple--; this allowed a correct diagnosis, at onset, of 20/32 (62%) invasive pulmonary aspergillosis cases. CT provided a further diagnostic contribution by showing a peri-nodular halo. Of interest was also the CT demonstration of high-density pleural thickening adjacent to the mycotic lesion, probably due to fungal involvement of the sub-pleural space. The routine chest roentgenogram is the modality of choice; CT may be useful in questionable cases.