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Dante Luiz EscuissatoDante Luiz Escuissato
Infections are related to specific immunity defects.
Phagocyte abnormalities and intravenous catheters: Aspergillus and Candida species.
T cell abnormalities and corticosteroid therapy: Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis, Pneumocystis jiroveci, and Candida species.
Am J Roentgenol 2005;185:608-615
Fusarium sp
Aspergillus sp
Pseudomonas sp.
Infections Fungal infections (invasive aspergillosis, candidiasis,
zygomycosis, fusariosis) Viral and bacterial infections
Neoplasia Bronchoalveolar carcinoma Kaposi sarcoma Angiosarcoma metastasis
Vasculitis (Wegener granulomatosis)Br J Radiol 2005;78:862-865
Chest X-ray: isolate or multiple nodular opacities, cavitate lesions, alveolar opacities.
CT: nodules and alveolar opacities, with or without the halo sign.
Radiographics 2001;21:825-837Braz J Infect Dis 2007;11:110-113
Halo sign: 33-60%, disappears after one week (~75%)
Recommendation: CT scan performed not beyond 5th day after symptoms onset.
CT scan: nodules, consolidations, and ground-glass opacities.
Candidiais and IPA: similar CT findings in immunocompromised patients.
Halo sign and cavitation not helpful to differentiate fungal infections.
Am J Roentgenol 2005;185:608-615
Radiology 2005;236:332-337
Zygomycosis: imaging abnormalites are similar to IPA in immunocompromised patients.
Cryptococcosis:one or more nodules and masses (up 10cm in diameter), consolidations, and diffuse reticular a/o nodular opacities. Cavitations are seen in immunocompromised patients.
Brodoefel et al.: ~3 lesions (40 patients) Lesions enlarges inicially (~ 9th day) stabilization
regression (Am J Roentgenol 2006;187:404-413)
Cavitation: indicative of favorable evolution.
1 2
18/01 25/01
Chest X-ray: screening for lesions in patients with neutropenia and fever.
High-resolution CT scan shows abnormalities not seen in chest X-rays.
HRCT: differential diagnosis (infectious and not infectious lesions).
Nodules >10mm and lesions with the halo sign associated to clinical context are enough to presume the diagnosis of pulmonary invasive fungal infection