Typical radiological findings and course of invasive pulmonary aspergillosis in immune-suppressed patients

Purpose: This retrospective study was designed to show whether invasive pulmonary aspergillosis, which is often difficult to diagnose by bronchoscopy or serology, can be diagnosed at an early stage by typical radiological findings on conventional radiographs or by CT, specially high resolution CT (HR-CT). Patients and Methods: In 19 Patients with 20 disease episodes, 20 thorax radiographs and eight spiral CT examinations were performed and in four cases HR-CT was also available. The earliest pathological findings and the course of the isease were analysed and the results of the various examinations were compared. Results: 90% of chest examinations, in cluding CT and HR-CT, showed the following lesions as part of the earliest changes: Round or wedge-shaped opacities or the so-called 'halo' sign. CT or HR-CT always demonstrated more lesions than plain chest radiographs; 75% of lesions appeared typical and thereby contributed to the diagnosis. Conclusion: The typical radiological findings of round or wedge-shaped opacities and the so-called 'halo' sign are additional criteria for the diagnosis of invasive pulmonary aspergillosis. The superiority of CT or HR-CT in the demonstration of pathological changes suggests that these should be used early in the investigation of patients who are specially at risk. (orig.)