Atypical imaging patterns during lung invasive mould diseases: lessons for clinicians

Area of Science:

• Medical Imaging
• Pulmonology
• Infectious Diseases

Background:

• Pulmonary invasive mould diseases (IMDs) are critical infections, particularly in immunocompromised patients.
• Computed tomography (CT) is the primary imaging modality for diagnosing IMDs.
• Atypical presentations are increasingly recognized in non-neutropenic patient groups.

Purpose of the Study:

• To review the CT features of pulmonary invasive mould diseases, focusing on aspergillosis and mucormycosis.
• To discuss atypical radiological findings in emerging at-risk patient populations.
• To evaluate the role of other imaging techniques like positron emission tomography/CT.

Main Methods:

• Review of CT imaging features of pulmonary invasive mould diseases.
• Analysis of atypical presentations in non-neutropenic patients undergoing novel therapies or in intensive care.
• Discussion of positron emission tomography/CT and vascular imaging.

Main Results:

• CT is the cornerstone for IMD diagnosis, with specific features for aspergillosis and mucormycosis.
• Atypical presentations are common in non-neutropenic patients, requiring careful interpretation.
• Positron emission tomography/CT and vascular assessment can aid diagnosis and management.

Conclusions:

• Airway-centered abnormalities or cavitated lesions on CT should raise suspicion for IMDs in mildly immunocompromised hosts.
• Non-specific imaging features and underlying patient conditions can complicate diagnosis.
• Considering differential diagnoses and vascular status is crucial for optimal patient management.