Comparison of CT features of Aspergillus and bacterial pneumonia in severely neutropenic patients.

Abstract:

PURPOSE:To establish whether a relationship exists between computed tomography features of lung opacities in severely neutropenic patients and their Aspergillus or bacterial etiology. METHODS:Computed tomography scans of 124 patients with lung opacities larger than 5 mm occurring during severe (neutrophils <500/mm) and prolonged (>7 d) neutropenia-induced by bone marrow transplantation and/or high-dose chemotherapy for hematologic malignancies-were reviewed. Invasive pulmonary aspergillosis or bacterial pneumonia were assessed by means of bronchoalveolar lavage, bronchial washing, trans-bronchial biopsy or (for bacteria only) blood cultures. Pulmonary opacities were classified as nodules or as consolidations. The presence of a perinodular ground-glass halo, the similarity of consolidations to a pulmonary infarction and the presence of cavitation (crescent-shaped or not) were recorded. RESULTS:Invasive pulmonary aspergillosis was diagnosed in 68 patients; bacterial pneumonia in 56. Nodules (85) were more common than consolidations (39); their distribution among the patients with aspergillosis (52 nodules and 16 consolidations) and those with bacterial pneumonia (33 nodules and 23 consolidations) was even. Out of the 19 nodules surrounded by a halo 17 were due to aspergillosis. Nine consolidations (3 due to aspergillosis) were infarctionlike shaped. Cavitation appeared during 22/68 aspergillosis and 31/56 bacterial pneumonias; an air-crescent in 6 patients with aspergillosis and in 24 with bacterial pneumonia. CONCLUSIONS:Although rare enough, the perinodular halo is highly specific for invasive aspergillosis. The nodular pattern of lung opacities, their similarity to a pulmonary infarction, the occurrence of cavitation and the air-crescent are not related to aspergillosis.

journal_name

J Thorac Imaging

authors

Bruno C,Minniti S,Vassanelli A,Pozzi-Mucelli R

doi

10.1097/RTI.0b013e31805f6a42

subject

Has Abstract

pub_date

2007-05-01 00:00:00

pages

160-5

issue

2

eissn

0883-5993

issn

1536-0237

pii

00005382-200705000-00009

journal_volume

22

pub_type

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