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Spectrum of Pulmonary Aspergillosis: Histologic, Clinical, and Radiologic Findings¹

¹ From the Departments of Radiology (T.F., A.G.) and Pathology (S.B.), Hospital de Sant Pau, Universidad Autónoma de Barcelona, Avda San Antonio Maria Claret 168, Barcelona 08125, Spain; the Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (N.L.M.); and the Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (P.G., J.d.l.T.). Presented as a scientific exhibit at the 1999 RSNA scientific assembly. Received September 1, 2000; revision requested October 10 and received November 22; accepted December 20. Address correspondence to T.F. (e-mail: 19429tfc@comb.es).

Aspergillosis is a serious pathologic condition caused by Aspergillus organisms and is frequently seen in immunocompromised patients. At computed tomography (CT), saprophytic aspergillosis (aspergilloma) is characterized by a mass with soft-tissue attenuation within a lung cavity. The mass is typically separated from the cavity wall by an airspace ("air crescent" sign) and is often associated with thickening of the wall and adjacent pleura. CT findings in allergic bronchopulmonary aspergillosis consist primarily of mucoid impaction and bronchiectasis involving predominantly the segmental and subsegmental bronchi of the upper lobes. Aspergillus necrotizing bronchitis may manifest as an endobronchial mass, obstructive pneumonitis or collapse, or a hilar mass. Bronchiolitis is characterized by centrilobular nodules and branching linear or nodular areas of increased attenuation ("tree-in-bud" pattern). Obstructing bronchopulmonary aspergillosis mimics allergic bronchopulmonary aspergillosis at CT and manifests as bilateral bronchial and bronchiolar dilatation, large mucoid impactions, and diffuse lower lobe consolidation caused by postobstructive atelectasis. Characteristic CT findings in angioinvasive aspergillosis consist of nodules surrounded by a halo of ground-glass attenuation ("halo sign") or pleura-based, wedge-shaped areas of consolidation. Although imaging findings in pulmonary aspergillosis may be nonspecific, in the appropriate clinical setting, familiarity with the CT findings may suggest or even help establish the diagnosis.

Index Terms: Aspergillosis, 60.2056, 60.254, 60.634 • Lung, cavitation, 60.2812 • Lung, consolidation • Lung, CT, 60.1211, 60.12118 • Lung, infection, 60.2056, 60.254, 60.634 • Lung, necrosis • Lung, nodule, 60.2812

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