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Air crescent sign of invasive aspergillosis
Abstract:
Pulmonary infection in immunocompromised patients is frequently difficult to diagnose. Therapy for the more common pathogens differs greatly from that for infection with unusual opportunistic organisms. However, neither of these infectious agents offers specific radiographic signs. The authors report on 4 patients with acute leukemia and invasive aspergillosis whose radiographs demonstrated a distinctive feature of one or more air crescents within an area of pulmonary infiltrate. Autopsy studies correlated the radiographic changes with an infection due to Aspergillus species fungi. While the sign is not pathognomonic for Aspergillus infection, seen in a suitable host, it would suggest the possibility of invasive aspergillosis.
Insights
Diagnosing pulmonary infections in immunocompromised patients is challenging. A specific air crescent sign on chest radiographs may indicate invasive aspergillosis in patients with acute leukemia.
Area of Science:
- Medical Imaging
- Mycology
- Infectious Diseases
Background:
- Pulmonary infections in immunocompromised patients present diagnostic challenges.
- Therapeutic strategies vary significantly between common and opportunistic pathogens.
- Radiographic signs are often non-specific for these infections.
Purpose of the Study:
- To identify distinctive radiographic features associated with pulmonary infections in immunocompromised patients.
- To investigate the correlation between radiographic findings and invasive aspergillosis.
- To assess the utility of the air crescent sign in diagnosing fungal infections.
Main Methods:
- Case series of 4 patients with acute leukemia and invasive aspergillosis.
- Review of radiographic findings, specifically focusing on pulmonary infiltrates.
- Correlation of radiographic observations with autopsy findings.
Main Results:
- All 4 patients exhibited one or more air crescents within pulmonary infiltrates on radiographs.
- Autopsy confirmed invasive aspergillosis due to Aspergillus species fungi.
- The air crescent sign was observed in the context of invasive fungal infection.
Conclusions:
- The air crescent sign, while not pathognomonic, is a suggestive finding for invasive aspergillosis.
- This radiographic feature can aid in the early diagnosis of fungal infections in susceptible hosts.
- Further investigation into radiographic signs for opportunistic infections is warranted.