Diagnostic Analysis of Computed Tomography Patterns in Patients With Invasive Pulmonary Aspergillosis After Solid-Organ Transplantation.

OBJECTIVES: The aim of this study was to assess initial and follow-up computed tomography findings of invasive pulmonary aspergillosis in solid-organ transplant recipients and to examine the most common computed tomography patterns during hospitalization.

MATERIALS AND METHODS: From January 2011 to September 2016, the total number of solid-organ transplant patients at our institution was 784. These patients consisted of 550 kidney, 164 liver, and 67 heart transplant recipients. Of these, 15 patients had a proven diagnosis of invasive pulmonary aspergillosis according to clinical and radiologic features with culture evidence of aspergillosis from bronchoalveolar lavage or lung biopsy. Computed tomography examinations were performed at initial diagnosis and at follow-up for evaluation of treatment. Computed tomography patterns were retrospectively evaluated by 2 experienced radiologists. Configurations and types of the largest lesions in each of the 15 patients were evaluated, and changes to lesions during treatment were recorded. Invasive pulmonary aspergillosis patterns were categorized into 6 main groups: ground-glass opacity, nodules, irregular nodules, patchy consolidation, cavity, and tree-in-bud patterns.

RESULTS: The most common patterns were ground-glass opacity and irregular nodules, which were observed in 12 of 15 patients (80%), followed by regular nodules (73%), patchy consolidation and cavity (26%), and tree-in-bud pattern (20%). Long-term follow-up computed tomography studies showed that the regular nodules, tree-in-bud patterns, and groundglass opacity areas gradually reduced by 50% in 4 weeks. However, patchy consolidations and irregular nodules showed less regression than the other lesions over the 4-week period.

CONCLUSIONS: Irregular nodules and ground-glass opacity were the most common computed tomography patterns in our solid-organ transplant recipients. Computed tomography patterns without irregular nodules and patchy consolidations may be associated with better prognosis due to their relatively rapid healing.