Pleuro-pulmonary aspergillosis. US and US-guided biopsy as an aid to diagnosis

We reviewed the US findings and the diagnostic yield of fine-needle aspiration biopsy (FNAB) for cytologic and microbiologic samples in 4 patients with pulmonary or pleural aspergillosis. All 3 apical Aspergillus abscesses were round, hypoechoic with irregular margins and one contained echo-densities with shadowing consistent with air. One pleural empyema was oval and hypoechoic. Cytology suggested inflammation in all cases and Aspergillus hyphae were detected in 2 of 4 aspirates. Culture of the aspirate was positive for Aspergillus in 3 of 4 cases, while one diagnosis was made after surgery. No complications occurred. Apico-pleural Aspergillus lesions are suitable targets for US-guided FNAB, thus avoiding more invasive methods. Our results suggest wider use of this procedure.