HRCT Features of Pulmonary Aspergillosis in Patients With Solid Organ Transplant


Shahram Kahkouee 1 , Davoud Kouchebaghi 1 , Mohammad Ali Karimi 2 , *

1 Department of Radiology, Masih-e-Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

2 Department of Radiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

How to Cite: Kahkouee S, Kouchebaghi D, Karimi M A. HRCT Features of Pulmonary Aspergillosis in Patients With Solid Organ Transplant, Iran J Radiol. Online ahead of Print ; 11(30th Iranian Congress of Radiology):e21268. doi: 10.5812/iranjradiol.21268.


Iranian Journal of Radiology: 11 (30th Iranian Congress of Radiology); e21268
Published Online: February 28, 2014
Article Type: Research Article


Background: Invasive pulmonary aspergillosis (IPA) is a serious infection in immunocompromised patients, especially in patients with organ transplant. By familiarizing with all radiologic features and early diagnosis of pulmonary aspergillosis, radiologists can play an important role in improving the outcome of these patients.

Objectives: The aim of this study was to determine the findings of IPA in HRCT of patients with solid organ transplant.

Patients and Methods: HRCT 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 transplants (18 pulmonary, 4 kidney, and one heart transplants). Mean time interval between transplant to the diagnosis of IPA was 8.10 (148) months. Comparison between the 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%), hypo dense 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%) and larger than 10mm (85%), and cavity was seen in 40% of nodules. Forty-six percent of GGOs were diffuse and 56% of them were patchy. Forty-two percent of consolidations were patchy and 58% of them were segmental or lobar. There were no significant differences in frequency of HRCT findings of IPA in terms of age, sex, type of transplant, or interval between organ transplant and IPA diagnosis.

Conclusions: The main radiologic manifestations of IPA, as observed in this study, are consistent with previous studies and include a combination of nodule, halo sign, GGO, consolidation and cavity. However, radiologists should also consider IPA with other findings such as nodular infiltration, hypo dense sign, and bronchiectasis, especially in the presence of at least one common feature and in the appropriate clinical setting.

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