CT features and clinical characteristics of invasive pulmonary aspergillosis complicated with hematopathy

To analyze the CT manifestations,clinical symptoms, laboratory test and the interrelationship of them with secondary invasive pulmonary aspergillosis (IPA) in hematologic patients so as to improve the diagnosis and prognosis of this disease.

A total of 37 hematologic patients suspected of IPA in a tertiary referral center were selectedfrom Jun. 2004 to Sep. 2016 and the CT characteristics, clinical manifestations, laboratory test of these patients were retrospectively analyzed.

There were 8 patients confirmed as IPA by sputum culture or bronchoalveolar lavage fluid culture among the 37 hematologic patients.The sensitivity of CT in the diagnosis of IPA was 75.0%, the specificity was 79.3%, the positive predictive value was 42.9%, and the negative predictive value was 91.3%. Multiple patchy shadows in both lungs were the most common CT signs of suspected and confirmed patients, followed by nodules, air bronchogram, cavitary lesions, consolidation, mass shadows, halo, and crescent sign. Cough, expectoration, and fever were the most common symptoms among the suspected and confirmed patients. β-D-glucan (G)/galactomannan antigen (GM) tests for the most patients were negative, but the number of people with elevated procalcitonin (PCT) in the confirmed patients (57.1%) was higher than that in the suspected patients (31.4%). Results of sputum culture, PCT, G/GM test, and clinical manifestations were compared between the CT lesion progression group and the absorption group, and no significant difference was observed.

Hematologic patients are susceptible to IPA. CT features showed no obvious specificity, and the G/GM test was normal in most patients. So when hematologic patients have clinical symptoms such as cough, expectoration and fever, the possibility of combination with IPA should be considered as soon as possible, and relevant examinations such as sputum culture, bronchoalveolar lavage fluid culture and pathological examination should be completed for early diagnosis and treatment to improve the prognosis of patients.