CHEST IMAGING: Immunocompromised

Case Author: Maria Shiau, MD, New York University School of Medicine, Langone Medical Center

History

57-year-old man with fever and neutropenia after heart transplant.

Imaging Findings

Axial CT images in lung windows (A and B) show patchy, nodular ground-glass opacity in the right middle and left lower lobes.

Diagnosis

Invasive aspergillosis

Teaching Points

Multiple nodules with a rim of ground-glass attenuation in a patient with neutropenia strongly suggest angioinvasive aspergillosis. Other fungal infections and cytomegalovirus pneumonia can have an identical radiographic appearance.

In patients with normal immunity, the differential diagnosis of multiple ground-glass nodules is broad and includes lung cancer, cryptogenic organizing pneumonia, and metastatic disease.

In the correct clinical situation, the presence of new nodules with the ground-glass halo sign is strongly suggestive of the diagnosis of angioinvasive aspergillosis, and treatment is usually initiated.

A definitive diagnosis can be made with bronchoscopic lung biopsy or transthoracic CT-guided needle biopsy.

Suggested Reading

Silva IS, Muller NL. The teaching file: chest. Philadelphia PA. Saunders Elsevier, 2010:158–159

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