Abstract : INTRODUCTION: Invasive pulmonary aspergillosis (IPA) is a serious infection in immunocompromised patiets, especially in transplant patients. By familiarity with all radiologic features and early diagnosis of pulmonary aspergillosis, radiologists can play an important role in improving outcome of these patients. The aim of this study was to determine the findings of IPA in HRCT of patients with solid organ transplant.

METHODS: HRC images of 23 patients with histopathologically proven IPA in Masih-e-Daneshvari hospital of Tehran from 2002 to 2011 were reviewed. All patients had solid organ transplant (18 pulmonary, 4 kidney, and one heart transplants). Mean time interval between transplant to diagnosis of IPA was 8 ± 10 (1-48) months. Comparison between subgroups was performed by Chi square and Fischer exact tests.

RESULTS: The Mean number of radiologic findings was 4. HRCT findings in order of decreasing frequency were: pulmonary nodule(s) (87%), halo sign (61%),  ground glass opacities (GGO) (56.5%), consolidation (52.5%), cavity (47.8%), nodular infiltration with or without tree-in-bud (43.5%), hypodense sign (21.7%), bronchiectasis (17.4%), pleural effusion (13%), interlobular septal thickening (13%), mass (4.3%), and air crescent sign(4.3%). Most of the nodules were multiple (80%), larger than 10mm (85%), and cavity was seen in 40% of nodules. Forty six percent of GGOs were diffuse and 56% were patchy. Forty two percent of consolidations were patchy and 58% were segmental or lobar. There were no significant differences in frequency of HRCT findings of IPA between age, sex, type of transplant, or interval groups. 

CONCLUSION:  The main features of IPA have not changed in comparison to previous studies and include a combination of nodule, halo sign, GGO, consolidation and cavity. Whoever, radiologist should consider IPA with other findings such as nodular infiltration, hypodense sign, and bronchiectasis, especially in the presence of at least one common feature and in the appropriate clinical setting.

HRCT Features of pulmonary aspergillosis in patients with solid organ transplant