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Varied radiologic appearances of pulmonary aspergillosis
B H Thompson1, W Stanford, J R Galvin
1Department of Radiology, University of Iowa College of Medicine, Iowa City 52242, USA.
Abstract:
Pulmonary aspergillosis represents a common, potentially lethal opportunistic infection that has four unique forms: allergic bronchopulmonary aspergillosis (ABPA), aspergilloma, and invasive and semi-invasive aspergillosis. In individuals who are at risk, pulmonary aspergillosis is characterized by a spectrum of clinical and radiographic findings that are intrinsically related to the status of the immune system or the presence of structural lung disease. ABPA, occurring almost exclusively in asthma patients, is characterized radiographically by fleeting pulmonary alveolar opacities caused by deposition of immune complexes and inflammatory cells within the lung parenchyma. Mucus plugging and bronchial wall thickening can be expected in time. Aspergilloma, occurring in patients with structural lung disease, typically appears radiographically as a focal intracavitary mass and is characterized initially by an increase in the wall thickness of a preexisting cavity or cyst. Invasive aspergillosis, which occurs primarily in profoundly immunocompromised patients, may exhibit nonspecific patchy nodular opacities or lobar-type air-space disease in cases with vascular invasion. Computed tomography may reveal a halo or ground-glass attenuation and is more accurate in the detection of early disease. Cavitation often develops with time and typically results in the air crescent sign. Semi-invasive aspergillosis is radiographically similar to the invasive form but differs in clinical course, being associated with mild immunosuppression or chronic illness and typically progressing over the course of months rather than weeks.
Insights
Pulmonary aspergillosis, a serious opportunistic infection, presents in four forms: ABPA, aspergilloma, invasive, and semi-invasive. Radiographic findings vary based on immune status and lung health, aiding diagnosis.
Area of Science:
- Pulmonology
- Infectious Diseases
- Radiology
Background:
- Pulmonary aspergillosis is a frequent, potentially fatal opportunistic infection.
- It manifests in four distinct forms: allergic bronchopulmonary aspergillosis (ABPA), aspergilloma, invasive, and semi-invasive aspergillosis.
- Clinical and radiographic findings are linked to immune status and structural lung disease.
Purpose of the Study:
- To describe the distinct clinical and radiographic features of the four forms of pulmonary aspergillosis.
- To highlight the relationship between imaging findings and patient immune status or underlying lung conditions.
Main Methods:
- Review of radiographic and clinical characteristics of pulmonary aspergillosis.
- Correlation of imaging findings with specific forms of the infection (ABPA, aspergilloma, invasive, semi-invasive).
Main Results:
- ABPA in asthma patients shows fleeting opacities, mucus plugging, and bronchial thickening.
- Aspergilloma appears as an intracavitary mass in structural lung disease.
- Invasive aspergillosis presents with nodular opacities or air-space disease, with CT showing halo/ground-glass signs and potential cavitation (air crescent sign).
- Semi-invasive aspergillosis shares radiographic similarities with invasive but has a slower clinical progression.
Conclusions:
- Pulmonary aspergillosis exhibits diverse radiographic presentations corresponding to its four forms.
- Radiographic findings are crucial for differentiating between the forms and assessing disease severity.
- Advanced imaging like CT enhances early detection and characterization of invasive aspergillosis.