CT findings and differential diagnosis in adults with invasive pulmonary aspergillosis

Abstract

ObjectiveTo investigate the CT findings and differential diagnosis in adults with invasive pulmonary aspergillosis among the population group and compare it with other traditional techniques to explore whether it can serve as a better tool. MethodsMedical records of the patients with invasive pulmonary aspergillosis from January 2006 to January 2016 selected retrospectively in Zhongnan Hospital of Wuhan University, China. All of the data, such as CT scan findings, pathological and sputum cultures from the patients were collected to analyze. Furthermore, the sensitivity and specificity of CT imaging were evaluated in the diagnosis and differentiation of adults with invasive pulmonary aspergillosis. ResultsA series of studies was analysed, and the results suggested that: invasive pulmonary aspergillosis as a series of radiological manifestations different from other types of pulmonary aspergillosis, which may help in its diagnosis and differential diagnosis. CT scans have similar or better value in early detection and differentiation of invasive pulmonary aspergillosis from other types of pulmonary aspergillosis. Three main CT findings were identified: small nodules (<1 cm) 38.7% (12/31), patchy or segmental consolidations 19.4% (6/31), large nodules (masses) 32.3% (10/31), and peribronchial infiltrates, associated or not with a tree in bud 9.7% (3/31). This study found a combination of two or more of these signs as follows: 6 patients presented with small nodules accompanied by reticulation, a tree in bud or peribronchial infiltrates, while two patients showed mainly large pulmonary masses. Crescent sign followed by cavitation was discovered in 9 patients (29.0%). Two patients succumbed to massive pulmonary bleeding caused by invasive pulmonary aspergillosis. Twenty-one patients deceased in this series, 12 of them succumbed to invasive pulmonary aspergillosis, one died from cerebral invasive aspergillosis, while in nine patients the causes of death were not mainly invasive pulmonary aspergillosis only. Manifest pulmonary haemorrhage occurred in 22.6% (7/31) of invasive pulmonary aspergillosis episodes. Further CT analysis of detecting invasive pulmonary aspergillosis obtained a high sensitivity of 90.3%(28/31) and a specificity of 89.5%(17/19). ConclusionsThe present study demonstrates that invasive pulmonary aspergillosis exhibit various features in the CT images, which are different from typical pneumonia and other kinds of lung diseases. These unique characteristics of invasive pulmonary aspergillosis shown in CT scan have comparable specificity and sensitivity to commonly used serum tests for invasive pulmonary aspergillosis. It indicates that CT analysis may help in detecting invasive pulmonary aspergillosis at the early stage, guide clinical intervention and reduce mortality and morbidity resulting from invasive pulmonary aspergillosis.