/
CH4 Pulmonary  aspergillosis CH4 Pulmonary  aspergillosis

CH4 Pulmonary aspergillosis - PowerPoint Presentation

gutsynumero
gutsynumero . @gutsynumero
Follow
342 views
Uploaded On 2020-06-23

CH4 Pulmonary aspergillosis - PPT Presentation

is a hot topic These infections are not unusual especially in the context of chronic obstructive pulmonary and immune depressed about The diagnosis can be strongly evoked in front of several radiological imaging ID: 784815

pulmonary aspergillosis results invasive aspergillosis pulmonary invasive results cases diagnosis patients lung aspergilloma shows nodules chronic air chest consolidation

Share:

Link:

Embed:

Download Presentation from below link

Download The PPT/PDF document "CH4 Pulmonary aspergillosis" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

CH4

Slide2

Pulmonary

aspergillosis

is a hot topic.

These infections are not unusual, especially in the context of chronic obstructive pulmonary and immune depressed about.

The diagnosis can be strongly evoked in front of several radiological imaging.

CT is more sensitive than plain films in the detection of occult or small lesion and more accurate in delineating the extent of disease and number of aspergillomas.Confident diagnosis is difficult, it is based on cytological and histological.

INTRODUCTION

Slide3

Show the interest of the scanner in the diagnosis of pulmonary

aspergillosis

.

Show radiological aspects of different forms.

Underpin suggestive radiological aspects.

OBJECTIVES:

Slide4

BACKGROUND

Pulmonary aspergillosis is a mycotic infection caused most of the times by A

spergillus Fumigatus

, an ubiquitous soil fungus acquired by inhaling its spores.

When we talk about aspergillosis we are referring to a spectrum of radiologic and clinical manifestations that depend directly of the immunological state of the patient and the

virulence of the organism.We can distinguish 4 types of pulmonary aspergillosis.• Aspergilloma (saprophytic aspergillosis)• Allergic bronchopulmonary aspergillosis (ABPA)• Semi-invasive or chronic necrotizing aspergillosis• Invasive aspergillosis (which can be divided into airway invasive and angioinvasive forms).

Slide5

MATERIALS AND METHODS:

A retrospective study involving 30 patients collected for department of radiology and lung diseases over 3 years.

Median age is 41 years (22- 67 years).

Chest CT scan was performed without injection of contrast and fine reformatted reconstructions in all patients. Bell in front of a picture, another acquisition in the prone position was performed. Histological confirmation was performed in all patients.

Slide6

Various underlying lung diseases

:

RESULTS:

COPD: chronic obstructive pulmonary disease

Slide7

RESULTS:

radiographic and CT findings were abnormal in all patients.

A

preoperative

diagnosis of aspergilloma considering :Their radiological examination in 20 cases.

Radiological examination and isolation of

Aspergillus

fumigatus

, in the bronchial aspirate in 2 cases.

A postoperative diagnosis of

aspergilloma

in 8 cases.

Slide8

RESULTS:

The spectrum of CT finding were:

Aspergilloma

with air crescent sign in 7 cases.

Bronchectasis in 4 cases.Chronic consolidation in 15 cases.Multiples nodules

with

progressive cavitation 18 cases.

Hydropneumothorax

in 2 cases.

Abcess

in 1 case.

Lung destruction in 3 cases.

Slide9

Prone

Supine

Saprophytic

aspergillom

. Supine (a)and prone (b) MDCT scans with lung windows show a gravity dependent

intracavitary

mass

a

b

a

b

Slide10

C

A

B: Bronchoscopic image shows elevated whitish nodular lesions in the trachea consistent with endobronchial growth of Aspergillus

B

D:

axial CT shows a consolidation in the right lower lobe with a central area of

Cavitation, the diagnosis of aspergilloma was considered, post opératory diagnosis was lung carcinoma.

D

A: Sagittal view shown two right upper lobe

aspergillomas

associated with bronchiectasis

C : axial CT shows Aspergilloma in 55 years old women identified air crescent upper lobe associated to a segmental area of consolidation surrounded by areas of ground-glass attenuation

Slide11

RESULTS:

Aspergilloma

:

Aspergillus

infection in immunocompetent host. The most common underlying causes: Tuberculosis, Sarcoidosis

, Emphysema, Bronchiectasis, Pneumoconiosis, Fibrotic lung disease, Neoplasm, Pulmonary infarction, Bronchogenic cyst, Pulmonary sequestration

and

Pneumatoceles

secondary

to

Pneumocystis

jirovecii

pneumonia

.

single, or multiples ones and it occurs predominantly in the upper lobes.

Clinical manifestation of

aspergilloma

is hemoptysis.

Slide12

RESULTS:

Aspergilloma

:

Chest radiographs and CT scans show:

A lung cavity containing a solid rounded mass which is separated from the wall by a rim of air. This feature is called the "air crescent"sign. Another common feature is the thickening of the cavity wall and the adjacent pleura.

This fungus ball may be

mobile

.

The

differential diagnosis

:

Hematoma.

Neoplasm.

Abscess,

Hydatid

cyst.

Wegener

granulomatosis

.

Slide13

Chest radiography:

CT:

Postero

anterior radiographs chest shows Upper lobe opacity surrounded by air crescent

:

fungus

ball

within

a

cavity

.

a

b

c

Chest

CT « a » axial « b » coronal shows a

fungus

ball

within

cavity

air

cresecent

Surrounded

this

cavity

, the

Chest

CT shows

also

bronchiesctasis

« 

»

associated

and multiples

basal

centrilobular

nodules « 

^

 ».

*

^

Slide14

RESULTS:

Allergic

bronchopulmonary

aspergillosis (ABPA):Characterized by the presence of fleeting dense plugs of mucus, hyphaes

and

eosinophils

in lung parenchyma due to deposition of immune complexes and inflammatory cells within the segmental and

subsegmental

bronchi.

ABPA represents a hypersensitivity reaction to

Aspergillus

occurring almost exclusively in long-standing bronchial asthma patients and occasionally as a complication of cystic

fibrosis

.

Slide15

RESULTS:

Allergic

bronchopulmonary

aspergillosis (ABPA):Clinically : wheezing, cough and fever.

Eosinophilia and elevated serum

IgE

levels are typically found and they can suggest the diagnosis.

Initial radiologic manifestations:

Transitory pulmonary opacities (deposition of immune complexes and inflammatory cells in the alveoli).

An irreversible damage occurs to the bronchi with dilatation, wall thickening and mucus

plugging

.

CT findings: tubular or

saccular

finger-in-glove areas of increased opacity in a bronchial distribution representing mucus plugging within

bronchiectasis

, predominantly involving the upper lobes.

Slide16

RESULTS:

Allergic

bronchopulmonary

aspergillosis (ABPA):The diagnosis is made by a combination of criteria:

Episodic asthma exacerbations.

Transient or fixed pulmonary infiltrates.

Central bronchiectasis.

Peripheral blood eosinophilia.

Elevated serum

IgE

levels.

Positive

Aspergillus

precipitins.

Slide17

Fig A : A pulmonary artery chest radiograph showing branching

“finger-in-glove” tubular opacities in the left lower lobe (retrocardiac)

due to mucus plugging of ectatic bronchi in ABPA

Fig C: High-resolution CT in the same patient as in Fig A, showing peribronchial thickening and apparent nodular opacities in the lower lobes due to bronchiectasis with mucoid impaction.

Fig B: High-resolution CT showing central bronchiectasis in ABPA.

The patient has had a previous left upper lobectomy for severebronchiectasis.

A

B

C

Slide18

RESULTS:

Chronic

necrotizing

pulmonary aspergillosis (CNPA) or semi-invasive aspergillosis:

Local and more indolent form of invasive pulmonary

aspergillosis

.

Patients with a chronic disease that

predispose

them

to infection.

Histologically: Presence of tissue necrosis and granulomatous inflammation similar to that seen in reactivated tuberculosis.

Slide19

RESULTS:

Chronic

necrotizing

pulmonary aspergillosis (CNPA) or semi-invasive aspergillosis:

Clinically: Chronic productive cough or with hemoptysis, which varies from severe to trivial.

Radiologically

:

chronic consolidation.

Multiples nodules with progressive cavitation in one or both upper lobes.

Non-specific, most commonly mimicking those of mycobacterial infection.

lesions are more peripheral, associate pleural thickening and

mayprogress

to form a

bronchopleural

fistula.

Slide20

A

B

C

D

Fig A: Posteroanterior chest radiograph shows area

of air-space consolidation in the right upper lobe

MDCT scan show a focal areas of

consolidation and nodules surrounded by an halo of ground-glass attenuation “fig B” one month after MDCT scan shows the evolution of the lesion which have increased in size and show a central area of cavitation “Fig C and D”. .

The diagnostic of CNPA

is

made after

positive

sputum

culture for

Aspergillus

.

Slide21

RESULTS:

Invasive

pulmonary

aspergillosis (IPA):Mortality : of up to 85%.Occurs in severe immunocompromised patients, especially in those with neutropenia due to hematologic malignancies, chemotherapy or immunosuppressive therapy

.

Depending on the route of spread we can discern two kinds of invasive

aspergillosis

:

Angioinvasive

.

Airway invasive.

which can even coexist in the same patient. However,

this is just a histological and

etiopathogenical

distinction as, in the clinical practice, this is not relevant for therapy.

Slide22

RESULTS:

Invasive

pulmonary

aspergillosis (IPA): Angioinvasive aspergillosis

Is histologically characterized by invasion of small to medium-sized vessels by fungal hyphae. This results in thrombus formation and vascular occlusion with the consequent tissue necrosis and systemic dissemination

.

CT scans shows:

Early IPA: Small nodules and/or small

pleuralbased,wedge

-shaped consolidations with a surrounding halo of ground-glass attenuation (halo sign). The halo sign represents alveolar hemorrhage.

As the disease progresses the nodules may

cavitate

, the necrotic parenchyma detaches from the adjacent lung forming an air crescent similar to that seen in

aspergilloma

.

In the

right clinical context,

nodules or consolidations surrounded by a ground-glass halo, progressing to cavitation or air crescent formation are considered typical of

angio

invasive

aspergillosis

.

Slide23

RESULTS:

Invasive

pulmonary

aspergillosis (IPA):Invasive aspergillosis of the airways :

14%-34% of cases of invasive

aspergillosis

.

Includes bronchitis and bronchiolitis, bronchopneumonia and lobar pneumonia without evidence of vascular invasion.

Surrounding the involved airway there is often a variably sized zone of hemorrhage and/

or

organizing

pneumonia

.

Slide24

RESULTS:

Invasive

pulmonary

aspergillosis (IPA):Invasive aspergillosis of the airways :

In the majority of cases, radiographic findings of invasive

aspergillosis

of the airways appear as:

Patchy

peribronchial

consolidation.

Centrilobular

nodules.

Areas of tree-in-bud pattern.

These features are non-specific and are indistinguishable from those of

bronchopneumonia caused by other microorganisms

.

Slide25

RESULTS:

Invasive

pulmonary

aspergillosis (IPA):Invasive aspergillosis of the airways :

This uncommon manifestation affects almost exclusively lung transplant recipients and

AIDS patients.

Patients experience cough, dyspnea and hemoptysis but they can also be asymptomatic.

CT scans are usually normal; sometimes a non-specific tracheal wall thickening is the only evident finding.

Bronchoscopy and fungal culture of the sputum proportionate a definitive diagnosis.

Slide26

IPA in a patient with cervix carcinoma and severe neutropenia (20 neutrophils/mm3) after chemotherapy. MDCT scan demonstrates bilateral multiple ill-defined nodules with peripheral ground-glass attenuation (a-b) and a segmental area of consolidation in the posterior segment of the middle lobe also surrounded by areas of ground-glass

attenuation

« .

Slide27

CONCLUSION:

Computed tomography has become a key consideration in the diagnosis of pulmonary aspergillosis and this in front of suggestive radiological aspects. It also determines the therapeutic.

Slide28

Bibliography

:

1- KOREN.L, ALONSO.S, Sanchez-Nistal.M.A,Mandich.D, Daimiel.I, Ayala.G;

Pulmonary aspergillosis; a spectrum of CT findings. ECR 2012: 1-22.

2- Caillot D, Couaillier JF, Bernard A, et al. Increasing volume and changing characteristics of invasive pulmonary aspergillosis on sequential thoracic computed tomography scans in patients with netropenia. J Clin Oncol 2001: 19:253-259.3- Franquet T, Müller N, Giménez A, Guembe P, De La Torre J, Bagué S. Spectrum of Pulmonary Aspergillosis: Histologic, Clinical, and Radiologic Findings. RadioGraphics 2001; 21:825-837.

4- R. Grech, A. Mizzi, S. Grech; Birkirkara/MT, BIRKIRKARA/MT.

The protean radiological appearances of pulmonary

Aspergillus infections. ECR 2011: 1-18.

5-

Presse Med. 2001 Apr 7;30(13):621-5. Role of computed tomography in

pulmonary aspergillosis. 20 cases Adil A, el Amraoui F, Kadiri R. Service Central de Radiologie, CHU Ibn Rochd, Casablanca, Maroc.

6- Ali Nawaz Khan, FRCP, FRCR, Carolyn Jones, MRCP, FRCR, and Sumaira Macdonald, MRCP FRCR. Bronchopulmonary Aspergillosis: A Review.

Curr Probl Diagn Radiol, July/August 2003. p156-168.