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CT findings in fungal opportunistic pneumonias: body and brain involvement
1Institute of Radiology, La Sapienza University, Rome, Italy.
Abstract:
A population of 28 immunocompromised hosts with proved pulmonary infections by Candida species (n = 18) or angioinvasive fungal pneumonias (Aspergillus species, n = 7, Mucor species n = 2, Trichosporon capitatum n = 1) were retrospectively examined for any characteristic computed tomographic (CT) pattern. Chest CT examination in angioinvasive fungal pneumonias (AFP) showed in all cases nodules or mass-like infiltrates. The mass/nodules were surrounded by a halo of low attenuation in early scans (n = 3/10) and showed often a peripheral enhancement in 6/8 contrast-enhanced scans. CT abnormalities in AFP were confined to the chest. Of the 18 patients with Candida pneumonias, 6 showed a mixed air space-interstitial pattern, 4 a granular pattern, 6 some type of mass-like consolidation, without neither perifocal halo nor postcontrast enhancement. In two autoptically proved cases, both chest plain film and CT scans were normal (false negatives). In CT body examinations, were found in 6 cases, other sites of organ involvement by Candida species (of brain in 1/6).
Insights
Computed tomography (CT) reveals distinct patterns for pulmonary fungal infections in immunocompromised patients. Angioinvasive fungal pneumonias show nodules/masses, while Candida pneumonias present varied patterns, highlighting CT
Area of Science:
- Medical Imaging
- Mycology
- Infectious Diseases
Background:
- Fungal pneumonias are serious infections in immunocompromised hosts.
- Accurate diagnosis relies on identifying characteristic imaging findings.
- Computed tomography (CT) is crucial for evaluating pulmonary infections.
Purpose of the Study:
- To retrospectively analyze and characterize CT patterns in immunocompromised patients with pulmonary fungal infections.
- To differentiate CT findings between angioinvasive fungal pneumonias (AFP) and Candida pneumonias.
- To assess the sensitivity of CT in detecting fungal pneumonia.
Main Methods:
- Retrospective analysis of CT scans from 28 immunocompromised patients.
- Inclusion criteria: proven pulmonary infections by Candida, Aspergillus, Mucor, or Trichosporon species.
- Detailed examination of CT features including nodules, infiltrates, halo signs, and contrast enhancement patterns.
Main Results:
- All cases of AFP demonstrated nodules or mass-like infiltrates.
- AFP lesions showed halo signs in early scans and peripheral enhancement in contrast-enhanced scans.
- Candida pneumonias exhibited mixed air space-interstitial patterns, granular patterns, or mass-like consolidations without halo or enhancement.
- CT scans were normal in two autoptically confirmed cases (false negatives).
- Extrapulmonary Candida involvement was detected in 6 patients via CT body examinations.
Conclusions:
- CT demonstrates characteristic patterns differentiating AFP from Candida pneumonias.
- CT is valuable for diagnosing pulmonary fungal infections but can have false negatives.
- Early detection of extrapulmonary dissemination is possible with CT body examinations.