Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 10/2015

01-10-2015 | Chest

Chronic Aspergillosis of the Lungs: Unravelling the Terminology and Radiology

Authors: S. R. Desai, V. Hedayati, K. Patel, D. M. Hansell

Published in: European Radiology | Issue 10/2015

Login to get access

Abstract

The propensity for Aspergillus spp. to cause lung disease has long been recognised but the satisfactory classification of these disorders is challenging. The problems caused by invasive disease in severely neutropenic patients, saprophytic infection of pre-existing fibrotic cavities and allergic reactions to Aspergillus are well documented. In contrast, a more chronic form of Aspergillus-related lung disease that has the potential to cause significant morbidity and mortality is under-reported. The symptoms of this form of Aspergillus infection may be non-specific and the radiologist may be the first to suspect a diagnosis of chronic pulmonary aspergillosis. The current review considers the classification conundrums in diseases caused by Aspergillus spp. and discusses the typical clinical and radiological profile of patients with chronic pulmonary aspergillosis.

Key Points

• The classification of Aspergillus -related lung disease is mired in confusion.
• The chronic form of Aspergillus infection is associated with significant morbidity and mortality.
• Progressive consolidation and cavitation with intracavitary material is the radiological hallmark.
Literature
1.
Sluyter T (1847) De vegetalibus organismi animalis parasitis. Diss Inaug Berlin
2.
Kradin RL, Mark EJ (2008) The pathology of pulmonary disorders due to Aspergillus spp. Arch Pathol Lab Med 132:606–614PubMed
3.
Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al (2008) Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 46:327–360CrossRefPubMed
4.
Georgiadou SP, Sipsas NV, Marom EM, Kontoyiannis DP (2011) The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts. Clin Infect Dis 52:1144–1155PubMedCentralCrossRefPubMed
5.
Marom EM, Kontoyiannis DP (2011) Imaging studies for diagnosing invasive fungal pneumonia in immunocompromised patients. Curr Opin Infect Dis 24:309–314CrossRefPubMed
6.
Denning DW, Pleuvry A, Cole DC (2011) Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis. Bull World Health Org 86:864–872CrossRef
7.
8.
Buckingham SJ, Hansell DM (2003) Aspergillus in the lung: diverse and coincident forms. Eur Radiol 13:1786–1800CrossRefPubMed
9.
10.
Denning DW (2001) Chronic forms of pulmonary aspergillosis. Clin Microbiol Infect Dis 7:25–31CrossRef
11.
Leggat PO, De Krester DM (1968) Aspergillus pneumonia in association with an aspergilloma. Brit J Dis Chest 62:147–150CrossRefPubMed
12.
Ein ME, Wallace RJ Jr, Williams TW Jr (1979) Allergic bronchopulmonary aspergillosis-like syndrome consequent to aspergilloma. Am Rev Respir Dis 119:811–820PubMed
13.
Shah A, Khan ZU, Chaturvedi S, Ramchandran S, Randhawa HS, Jaggi OP (1989) Allergic bronchopulmonary aspergillosis with coexistent aspergilloma: a long-term followup. J Asthma 26:109–115CrossRefPubMed
14.
Safirstein BH (1973) Aspergilloma consequent to allergic bronchopulmonary aspergillosis. Am Rev Respir Dis 108:940–943PubMed
15.
16.
Greene R (1981) The pulmonary aspergilloses: three distinct entities or a spectrum of disease. Radiology 140:527–530CrossRefPubMed
17.
Ganassini A, Cazzadori A (1995) Invasive pulmonary aspergillosis complicating allergic bronchopulmonary aspergillosis. Respir Med 89:143–145CrossRefPubMed
18.
19.
20.
Fraser RS (1993) Pulmonary aspergillosis: pathologic and pathogenetic features. Pathol Annu 28:231–277PubMed
21.
Gefter WB, Weingrad TR, Epstein DM, Ochs RH, Miller WT (1981) “Semi-invasive” pulmonary aspergillosis: a new look at the spectrum of Aspergillus infections of the lung. Radiology 140:313–321CrossRefPubMed
22.
Denning DW, Riniotis K, Dobrashian R, Sambatakou H (2003) Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review. Clin Infect Dis 37:S265–S280CrossRefPubMed
23.
Smith NLD, Denning DW (2014) Clinical implications of interferon gamma genetic and epigenetic variants. Immunology 143:499–511CrossRefPubMed
24.
Murdock BJ, Shreiner AB, Mcdonald RA, Osterholzer JJ, White ES, Toews GB et al (2011) Coevolution Of TH1, TH2, and TH17 responses during repeated pulmonary exposure to Aspergillus fumigatus conidia. Infect Immun 79:125–135PubMedCentralCrossRefPubMed
25.
Smith NL, Denning DW (2011) Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir J 37:865–872CrossRefPubMed
26.
Nam H-S, Jeon K, Um S-W, Suh GY, Chung MP, Kim H et al (2010) Clinical characteristics and treatment outcomes of chronic necrotizing pulmonary aspergillosis: a review of 43 cases. Int J Infect Dis 14:E479–E482CrossRefPubMed
27.
Ohba H, Miwa S, Shirai M, Kanai M, Eifuku T, Suda T et al (2012) Clinical characteristics and prognosis of chronic pulmonary aspergillosis. Respir Med 106:724–729CrossRefPubMed
28.
Camara B, Reymond E, Saint-Raymond C, Roth H, Brenier-Pinchart MP, Pinel C et al (2014) Characteristics and outcomes of chronic pulmonary aspergillosis: a retrospective analysis of a tertiary hospital registry. Clin Respir J. doi:10.​1111/​crj.​12105 PubMed
29.
Izumikawa K, Tashiro M, Kohno S (2012) Management of chronic aspergillosis. Ann N Y Acad Sci 1272:40–48CrossRefPubMed
30.
Yousem SA (1997) The histological spectrum of chronic necrotizing forms of pulmonary aspergillosis. Hum Pathol 28:650–656CrossRefPubMed
31.
32.
Libshitz HI, Atkinson GW, Israel HL (1974) Pleural thickening as a manifestation of Aspergillus suprinfection. Am J Roentgenol 120:883–886CrossRef
33.
34.
Sansom HE, Baque-Juston MC, Wells AU, Hansell DM (2000) Lateral cavity wall thickening as an early radiographic sign of mycetoma formation. Eur Radiol 10:387–390CrossRefPubMed
35.
Franquet T, Giménez A, Cremades R, Domingo P, Plaza V (2000) Spontaneous reversibilty of “pleural thickening” in a patient with semi-invasive pulmonary aspergillosis: radiographic and CT findings. Eur Radiol 10:722–724CrossRefPubMed
36.
Frankel SK, Cool CD, Lynch DA, Brown KK (2004) Idiopathic pleuroparenchymal fibroelastosis: description of a novel clinicopathologic entity. Chest 26:2007–2013CrossRef
37.
Becker CD, Gil J, Padilla ML (2008) Idiopathic pleuroparenchymal fibroelastosis: an unrecognized or misdiagnosed entity? Mod Pathol 21:784–787CrossRefPubMed
38.
Reddy TL, Tominaga M, Hansell DM, Von Der Thusen J, Rassl D, Parfrey H et al (2012) Pleuroparenchymal fibroelastosis: a spectrum of histopathological and imaging phenotypes. Eur Respir J 40:377–385CrossRefPubMed
39.
Piciucchi S, Tomassetti S, Casoni G, Sverzellati N, Carloni A, Dubini A et al (2011) High resolution CT and histological findings in idiopathic pleuroparenchymal fibroelastosis: features and differential diagnosis. Resp Res 12:1–5CrossRef
40.
Hafeez I, Muers MF, Murphy SA, Evans EGV, Barton RC, McWhinney P (2000) Non-tuberculous mycobacterial lung infection complicated by chronic necrotising pulmonary aspergillosis. Thorax 55:717–719PubMedCentralCrossRefPubMed
41.
Zoumot Z, Boutou AK, Gill SS, Van Zeller M, Hansell DM, Wells AU et al (2014) Mycobacterium avium complex infection in non-cystic fibrosis bronchiectasis. Respirology 19:714–722CrossRefPubMed
42.
43.
Choudat D, Horreard P, Pretet S, Grosset J, Toty L (1986) Superinfection by Aspergillus fumigatus of a pulmonary lesion caused by Mycobacterium xenopi. Tubercle 67:71–74CrossRefPubMed
44.
Böllert FGE, Sime PJ, Macnee W, Crompton GK (1994) Pulmonary Mycobacterium malmoense and aspergillus infection: a fatal combination? Thorax 49:521–522PubMedCentralCrossRefPubMed
45.
Hansell DM, Bankier AA, Macmahon H, Mcloud TC, Müller NL, Remy J (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246:697–722CrossRefPubMed
46.
Franquet T, Müller NL, Giménez A, Domingo P, Plaza V, Bordes R (2000) Semiinvasive pulmonary aspegillosis in chronic obstructive pulmonary disease: radiologic and pathologic findings in nine patients. AJR 174:51–56CrossRefPubMed
47.
Kim SY, Lee KS, Han J, Kim J, Kim TS, Choo SW et al (2000) Semiinvasive pulmonary aspergillosis: CT and pathologic findings in six patients. AJR 174:795–798CrossRefPubMed
48.
Sambatakou H, Dupont B, Lode H, Denning DW (2006) Voriconazole treatment for subacute invasive and chronic pulmonary aspergillosis. Am J Med 119:527CrossRefPubMed
49.
Koyama K, Ohshima N, Suzuki J, Kawashima M, Takeda K, Ando T et al (2014) Recurrence of chronic pulmonary aspergillosis after discontinuation of maintenance treatment by antifungal triazoles. J Infect Chemother 20:375–379CrossRefPubMed
Metadata
Title
Chronic Aspergillosis of the Lungs: Unravelling the Terminology and Radiology
Authors
S. R. Desai
V. Hedayati
K. Patel
D. M. Hansell
Publication date
01-10-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 10/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3690-7

Other articles of this Issue 10/2015

European Radiology 10/2015 Go to the issue

Musculoskeletal

Increased signal intensity at the proximal patellar tendon: correlation between MR imaging and histology in eight cadavers and clinical MR imaging studies

Magnetic Resonance

Proton density fat-fraction is an accurate biomarker of hepatic steatosis in adolescent girls and young women

Radiological Education

The use of lower resolution viewing devices for mammographic interpretation: implications for education and training

Musculoskeletal

Bone marrow involvement in Gaucher disease at MRI : what long-term evolution can we expect under enzyme replacement therapy?

Head and Neck

Diagnostic utility of Acoustic Radiation Force Impulse (ARFI) imaging in primary Sjoegren`s syndrome

Nuclear Medicine

18-F fluorodeoxyglucose uptake in positron emission tomography as a pathological grade predictor for renal clear cell carcinomas