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Invasive Aspergillosis
Tomás Franquet, MD, PhD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Invasive pulmonary aspergillosis
            • Definitions

              • Infection caused by saprophytic and ubiquitous airborne filamentous fungus Aspergillus species (usually Aspergillus fumigatus)
                • Other species: Aspergillus flavus, Aspergillus niger
                • Affects almost exclusively immunocompromised patients with severe neutropenia: Absolute neutrophil count < 500 per μL
              • Angioinvasive aspergillosis
                • Most common form of invasive aspergillosis
                • Occlusion of small to medium-sized pulmonary arteries by fungal hyphae
                • Wedge-shaped subpleural consolidation corresponding to hemorrhagic infarct
              • Airway-invasive aspergillosis
                • Rare form of invasive aspergillosis
                • Fungal hyphae beyond airway basement membrane

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Prasad A et al: Pulmonary aspergillosis: what CT can offer before it is too late! J Clin Diagn Res. 10(4):TE01-5, 2016
                                      2. Chabi ML et al: Pulmonary aspergillosis. Diagn Interv Imaging. 96(5):435-42, 2015
                                      3. Stanzani M et al: High resolution computed tomography angiography improves the radiographic diagnosis of invasive mold disease in patients with hematological malignancies. Clin Infect Dis. 60(11):1603-10, 2015
                                      4. Walsh S et al: Importance of the reversed halo sign for the diagnosis of angioinvasive pulmonary aspergillosis. Respir Med. 108(8):1240, 2014
                                      5. Xu XY et al: Diagnosis of airway-invasive pulmonary aspergillosis by tree-in-bud sign in an immunocompetent patient: case report and literature review. J Mycol Med. 23(1):64-9, 2013
                                      6. Georgiadou SP et al: The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts. Clin Infect Dis. 52(9):1144-55, 2011
                                      7. Greene RE et al: Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign. Clin Infect Dis. 44(3):373-9, 2007
                                      8. Althoff Souza C et al: Pulmonary invasive aspergillosis and candidiasis in immunocompromised patients: a comparative study of the high-resolution CT findings. J Thorac Imaging. 21(3):184-9, 2006
                                      9. Horger M et al: Invasive pulmonary aspergillosis: frequency and meaning of the "hypodense sign" on unenhanced CT. Br J Radiol. 78(932):697-703, 2005
                                      10. Franquet T et al: Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics. 21(4):825-37, 2001
                                      11. Primack SL et al: Pulmonary nodules and the CT halo sign. Radiology. 190(2):513-5, 1994
                                      12. Kuhlman JE et al: Invasive pulmonary aspergillosis in acute leukemia. The contribution of CT to early diagnosis and aggressive management. Chest. 92(1):95-9, 1987
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Synonyms

                                                  • Invasive pulmonary aspergillosis
                                                • Definitions

                                                  • Infection caused by saprophytic and ubiquitous airborne filamentous fungus Aspergillus species (usually Aspergillus fumigatus)
                                                    • Other species: Aspergillus flavus, Aspergillus niger
                                                    • Affects almost exclusively immunocompromised patients with severe neutropenia: Absolute neutrophil count < 500 per μL
                                                  • Angioinvasive aspergillosis
                                                    • Most common form of invasive aspergillosis
                                                    • Occlusion of small to medium-sized pulmonary arteries by fungal hyphae
                                                    • Wedge-shaped subpleural consolidation corresponding to hemorrhagic infarct
                                                  • Airway-invasive aspergillosis
                                                    • Rare form of invasive aspergillosis
                                                    • Fungal hyphae beyond airway basement membrane

                                                IMAGING

                                                • General Features

                                                  • Radiographic Findings

                                                    • CT Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Gross Pathologic & Surgical Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Prasad A et al: Pulmonary aspergillosis: what CT can offer before it is too late! J Clin Diagn Res. 10(4):TE01-5, 2016
                                                                          2. Chabi ML et al: Pulmonary aspergillosis. Diagn Interv Imaging. 96(5):435-42, 2015
                                                                          3. Stanzani M et al: High resolution computed tomography angiography improves the radiographic diagnosis of invasive mold disease in patients with hematological malignancies. Clin Infect Dis. 60(11):1603-10, 2015
                                                                          4. Walsh S et al: Importance of the reversed halo sign for the diagnosis of angioinvasive pulmonary aspergillosis. Respir Med. 108(8):1240, 2014
                                                                          5. Xu XY et al: Diagnosis of airway-invasive pulmonary aspergillosis by tree-in-bud sign in an immunocompetent patient: case report and literature review. J Mycol Med. 23(1):64-9, 2013
                                                                          6. Georgiadou SP et al: The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts. Clin Infect Dis. 52(9):1144-55, 2011
                                                                          7. Greene RE et al: Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign. Clin Infect Dis. 44(3):373-9, 2007
                                                                          8. Althoff Souza C et al: Pulmonary invasive aspergillosis and candidiasis in immunocompromised patients: a comparative study of the high-resolution CT findings. J Thorac Imaging. 21(3):184-9, 2006
                                                                          9. Horger M et al: Invasive pulmonary aspergillosis: frequency and meaning of the "hypodense sign" on unenhanced CT. Br J Radiol. 78(932):697-703, 2005
                                                                          10. Franquet T et al: Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics. 21(4):825-37, 2001
                                                                          11. Primack SL et al: Pulmonary nodules and the CT halo sign. Radiology. 190(2):513-5, 1994
                                                                          12. Kuhlman JE et al: Invasive pulmonary aspergillosis in acute leukemia. The contribution of CT to early diagnosis and aggressive management. Chest. 92(1):95-9, 1987