Computed tomography in invasive pulmonary aspergillosis

Early recognition of invasive pulmonary aspergillosis and of other similar angiotrophic fungal pneumonias has been claimed in previous reports to be possible with computed tomography (CT) and may improve survival of immunocompromised hosts. Chest CT was performed, in the course of fungal pneumonia, in 11 leukemia patients with chemotherapy-induced neutropenia either with (n = 8) or without (n = 5) contrast enhancement. Early (n = 5), before the 7th day from the beginning of the clinical setting) chest CT always demonstrated one or more nodules or mass-like infiltrates surrounded by a halo of low attenuation. This halo was absent in middle (n = 4, after 7 days) and later (n = 4, after 15 days) CT examinations. The contrast-enhanced nodules or mass-like infiltrates showed a peripheral enhancement in 4/8 cases with a target feature (hyperdense peripheral ring and isodense central area). CT showed a non-specific enlargement of liver and spleen in 2 patients. Early chest CT should be used in the management of opportunistic pneumonias.