European Journal of Radiology, 14 (1992) 37-40 0 1992 Elsevier Science Publishers B.V. All rights reserved. 0720-048X/92/$05.00 37 EURRAD 00224 zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Invasive aspergillosis in immunocompromised (HR)CT patients: findings on plain film and Huub L.M. Pasmansl, Olaf J.L. Loosveld2, Harry C. Schouten2, Frederik Thunnissen3 and Jos M.A. van Engelshoven’ Departments of ‘Diagnostic Radiology, ‘Internal Medicine and ‘Pathology, University Hospital Maastricht, The Netherlands (Received 18 April 1991; accepted after revision 30 July 1991) Key words: Thorax, aspergillosis; Thorax, radiography; Aspergillosis, CT Abstract The CT and plain chest film abnormalities in eight patients with invasive pulmonary aspergillosis (IPA) are described and compared, The various radiologic findings of IPA were (sub)segmental and patchy consolidation, cavitation and an air crescent sign. CT had a higher sensitivity for multiplicity of lesions and cavitation compared with the plain chest film. Because these abnormalities are keypoints of the diagnosis, CT is recommended in patients suspected of IPA. Introduction Pulmonary aspergillosis is a mycotic disease with diverse clinical and radiological manifestations ranging from allergic bronchopulmonary aspergillosis to inva- sive pulmonary aspergillosis (IPA). IPA is generally limited to severe immunocompromised or chronic de- bilitated patients, causing a high morbidity and mortali- ty [ 1,2]. An early diagnosis is important but difficult because the clinical and radiological findings may be subtle and non-specific. The clinical and radiological findings in 8 patients with IPA are presented and the role of CT in making the diagnosis is discussed. Materials and Methods From March to December 1989, eight patients under treatment for a malignancy were suspected clinically and radiologically of IPA. Six patients were male and two were female, with an age range of 19-50 years (mean 40 years). Five patients had acute leukemia, two Address for reprints: H.L.M. Pasmans, M.D., Department of Diagnostic Radiology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. non-Hodgkin’s lymphoma and one had metastatic rec- tal carcinoma. Six of them were treated with chemo- therapy and two underwent high-dose therapy followed by an autologous bone marrow transplantation. The clinical suspicion on IPA was always based on a combination of clinical history, fever, granulopenia ( < 500/mm3) and chest film abnormalities. CT scans of the lungs were obtained with a Somaton Plus CT scanner (Siemens, Erlangen) using 10 mm contiguous slices (0.7 s, 140 mAs, 120 kVp and standard algorithm). Additionally, some 1 mm slices of the in- volved area (0.7 s, 170 mAs, 137 kVp, and bone algorithm) were made in two patients. In two patients no CT scan was made because of their clinical con- dition. All patients had undergone bronchoalveolar lavage (BAL). The definite diagnosis of IPA was estab- lished by a positive culture from BAL (n = 3), or histological examinations (n = 3; Fig. la and b). In two patients the diagnosis was established solely on clinical and radiological grounds. The CT scans and compara- tive chest films (obtained within 3 days of each other) were analyzed retrospectively with specific reference to the observed radiologic pattern of infiltrates, the multi- plicity of lesions and the existence of cavitation with or without an air crescent or halo sign.