Imaging |

Invasive Pulmonary Aspergillosis in Solid Organ Transplant Patients: A CT Challenge FREE TO VIEW

Shahram Kahkouee, MD; Leila Mosadegh, MD; Davood Kouche baghi, MD; Sandbad Armand, MD
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Chronic Respiratory Diseases Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran

Chest. 2013;144(4_MeetingAbstracts):594A. doi:10.1378/chest.1702181
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SESSION TITLE: Imaging Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Invasive aspergillosis is a well known lethal disease in immunocompromised patients and the diagnosis mostly depends on tissue sampling and histopathology study. However the diagnostic role of imaging modalities for invasive aspergillosis has been highlighted in recent studies.

METHODS: this retrospective study is conducted on 23 solid organ transplant patients including 18 lung,4 kidney and 1 heart transplantation with mean age of 33.6 +- 11.6, ranged from 20 to 58 years. All cases were diagnosed with invasive pulmonary aspergillosis based on lung biopsy and histopathology study.HRCT and spiral chest CT scans were observed by a radiologist expert in chest imaging.The average time interval between transplantation and the diagnosis was about 8 months.

RESULTS: each patient manifests at least two of our variables.HRCT findings, in order of prevalence, were pulmonary nodules 87%, halo sign 61%, ground glass opacity (GGO) 56.5%, consolidation 52.5%, cavity 47.8%, nodular infiltration with or without Tree in Buds pattern43.5%, hypodense sign21.7%, bronchiectasia17.4%, pleural effusion13%, interlobular septal thickening13%, pulmonary mass4.3% and air crescent sign4.3%. Pulmonary nodules were mostly seen in multiple pattern (80%) and >10mm in size (85%) and 40% of them were excavated. Regarding GGO, 46%diffuse and 56% patchy were found and of consolidation, 42% patchy and 58% segmental were reported. Variables demonstrated no statistically significant difference in terms of age, gender, type of transplantation and post transplant period.

CONCLUSIONS: invasive pulmonary aspergillosis has not changed compared to previous documents and includes combination of multiple parenchymal nodules, halo sign, GGO, consolidation and cavity. Nevertheless, invasive pulmonary aspergillosis may present with some less common imaging findings like nodular infiltration, bronchiectasia and hypodense sign and radiologists and clinicians should be awared of that in the presence of suspicious clinical settings.

CLINICAL IMPLICATIONS: Invasive aspergillosis is a well known lethal disease in immunocompromised patients and highlighting imaging features will lead to easier and earlier diagnosis

DISCLOSURE: The following authors have nothing to disclose: Shahram Kahkouee, Leila Mosadegh, Davood Kouche baghi, Sandbad Armand

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