Pediatric Pulmonary and Thoracic Aspergillosis

Abstract

Aspergillus infection can cause significant disease in an immunocompromised host and lungs are the most common site of infection. Various forms of aspergillus involving lung parenchyma have been described including aspergilloma, allergic bronchopulmonary aspergillosis (ABPA), and semi-invasive and invasive pulmonary aspergillosis (IPA).

Pulmonary aspergilloma usually occurs in patients with pre-existing cystic lung diseases. The classic radiographic finding is a discrete, round or oval mass in a pulmonary cavity, which moves with gravity. Allergic bronchopulmonary aspergillosis is characterized by clinical asthma, blood and sputum eosinophilia and positive immunologic reaction to aspergillus antigen. Central bronchiectasis in patients with asthma is highly suggestive of ABPA. Invasive pulmonary aspergillosis is usually fatal infection in patients taking immunosuppressants. Infection can also spread to other visceral organs. Multiple and solitary nodular densities as well as diffuse or focal consolidation have been reported. CT halo sign and CT hypodense signs are suggestive of IPA.

Other forms of thoracic aspergillosis may include pleural aspergillosis, which can cause empyema. Osteomyelitis of the thoracic cage has been reported particularly in association with chronic granulomatous disease.

We would like to demonstrate pertinent clinical and radiographic features of pulmonary and thoracic involvement of aspergillosis including radiographic differential diagnoses.