Kosmidis C , Denning DW , 2015. The clinical spectrum of pulmonary aspergillosis. Thorax 70: 270–277.
Franquet T , Müller NL , Giménez A , Guembe P , de La Torre J , Bagué S , 2001. Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics 21: 825–837.
Kanj A , Abdallah N , Soubani AO , 2018. The spectrum of pulmonary aspergillosis. Respir Med 141: 121–131.
Smith NL , Denning DW , 2011. Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir J 37: 865–872.
Allwood BW , Byrne A , Meghji J , Rachow A , van der Zalm MM , Schoch OD , 2021. Post-tuberculosis lung disease: clinical review of an under-recognised global challenge. Respiration 100: 751–763.
Phoompoung P , Chayakulkeeree M , 2020. Chronic pulmonary aspergillosis following nontuberculous mycobacterial infections: an emerging disease. J Fungi (Basel) 6: 346.
Van Braeckel E et al., 2022. Treatment outcome definitions in chronic pulmonary aspergillosis: a CPAnet consensus statement. Eur Respir J 2: 2102950.
Schweer KE et al., 2014. Chronic pulmonary aspergillosis. Mycoses 57: 257–270.
Jhun BW et al., 2013. Clinical characteristics and treatment outcomes of chronic pulmonary aspergillosis. Med Mycol 51: 811–817.
Pena TA , Soubani AO , Samavati L , 2011. Aspergillus lung disease in patients with sarcoidosis: a case series and review of the literature. Lung 189: 167–172.
Denning DW et al., 2016. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J 47: 45–68.
Patterson TF et al., 2016. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the infectious diseases society of America. Clin Infect Dis 63: e1–e60.
Ullmann AJ et al., 2018. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect 24: e1–e38.
Sehgal IS , Choudhary H , Dhooria S , Aggarwal AN , Garg M , Chakrabarti A , Agarwal R , 2018. Diagnostic cut-off of Aspergillus fumigatus-specific IgG in the diagnosis of chronic pulmonary aspergillosis. Mycoses 61: 770–776.
Sehgal IS , Dhooria S , Choudhary H , Aggarwal AN , Garg M , Chakrabarti A , Agarwal R , 2019. Utility of serum and bronchoalveolar lavage fluid galactomannan in diagnosis of chronic pulmonary aspergillosis. J Clin Microbiol 27: e01821-18.
Kono Y et al., 2013. The utility of galactomannan antigen in the bronchial washing and serum for diagnosing pulmonary aspergillosis. Respir Med 107: 1094–1100.
Baluku JB , Nuwagira E , Bongomin F , Denning DW , 2021. Pulmonary TB and chronic pulmonary aspergillosis: clinical differences and similarities. Int J Tuberc Lung Dis 25: 537–546.
Denning DW et al., 2018. Case definition of chronic pulmonary aspergillosis in resource-constrained settings. Emerg Infect Dis 24: e171312.
Page ID et al., 2019. Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation. Eur Respir J 53: 1801184.
Perfect JR et al., 2001. The impact of culture isolation of Aspergillus species: a hospital-based survey of aspergillosis. Clin Infect Dis 33: 1824–1833.
Ohba H et al., 2012. Clinical characteristics and prognosis of chronic pulmonary aspergillosis. Respir Med 106: 724–729.
Carlos Severo L , Resin Geyer G , da Silva Porto N , Bernardes Wagner M , Thomaz Londero A , 1997. Pulmonary Aspergillus niger intra-cavitary colonization. Report of 23 cases and a review of the literature. Rev Iberoam Micol 14: 104–110.
Muldoon EG , Strek ME , Patterson KC , 2017. Allergic and noninvasive infectious pulmonary aspergillosis syndromes. Clin Chest Med 38: 521–534.
Singh R , Garg M , Sodhi KS , Prabhakar N , Singh P , Agarwal R , Malhotra P , 2020. Diagnostic accuracy of magnetic resonance imaging in the evaluation of pulmonary infections in immunocompromised patients. Pol J Radiol 85: e53–e61.
Rolle AM et al., 2016. ImmunoPET/MR imaging allows specific detection of Aspergillus fumigatus lung infection in vivo. Proc Natl Acad Sci USA 113: E1026–E1033.
Aquino SL , Lee ST , Warnock ML , Gamsu G , 1994. Pulmonary aspergillosis: imaging findings with pathologic correlation. AJR Am J Roentgenol 163: 811–815.
Gefter WB , 1992. The spectrum of pulmonary aspergillosis. J Thorac Imaging 7: 56–74.
Logan PM , Müller NL , 1996. CT manifestations of pulmonary aspergillosis. Crit Rev Diagn Imaging 37: 1–37.
Fraser RG et al., 1999. Fungal infections. Diagnosis of Diseases of the Chest. Philadelphia, PA: Saunders; 919–945.
Thompson BH et al., 1995. Varied radiologic appearances of pulmonary aspergillosis. Radiographics 15: 1273–1284.
Irwin A , 1967. Radiology of the aspergilloma. Clin Radiol 18: 432–438.
Roberts CM , Citron KM , Strickland B , 1987. Intrathoracic aspergilloma: role of CT in diagnosis and treatment. Radiology 165: 123–128.
Restrepo CS , Katre R , Mumbower A , 2016. Imaging manifestations of thoracic tuberculosis. Radiol Clin 54: 453–473.
Vishak KA et al., 2014. A rare case of calcified pulmonary aspergilloma. Lung India 31: 79–81.
Yeo CD , Baeg MK , Kim JW , 2012. A case of endobronchial aspergilloma presenting as a broncholith. Am J Med Sci 343: 501–503.
Park Y et al., 2007. Pulmonary cavitary mass containing a mural nodule: differential diagnosis between intracavitary aspergilloma and cavitating lung cancer on contrast-enhanced computed tomography. Clin Radiol 62: 227–232.
Greene R , 2005. The radiological spectrum of pulmonary aspergillosis. Med Mycol 43 (Suppl 1 ):S147–S154.
Greene R , 1981. The pulmonary aspergilloses: three distinct entities or a spectrum of disease. Radiology 140: 527–530.
Klein DL , Gamsu G , 1980. Thoracic manifestations of aspergillosis. AJR Am J Roentgenol 134: 543–552.
Gefter WB , 1992. The spectrum of pulmonary aspergillosis. J Thorac Imaging 7: 56–74.
Denning DW et al., 2003. Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review. Clin Infect Dis 37 (Suppl. 3 ):S265–S280.
Wilopo B , Richardson M , Denning D , 2019. Diagnostic aspects of chronic pulmonary aspergillosis: present and new directions. Curr Fungal Infect Rep 13: 292–300.
Godet C et al., 2014. Chronic pulmonary aspergillosis: an update on diagnosis and treatment. Respiration 88: 162–174.
Soubani AO , Chandrasekar PH , 2002. The clinical spectrum of pulmonary aspergillosis. Chest 121: 1988–1999.
Binder RE et al., 1982. Chronic necrotizing pulmonary aspergillosis: a discrete clinical entity. Medicine (Baltimore) 61: 109–124.
Yousem S , 1997. The histological spectrum of chronic necrotizing forms of pulmonary aspergillosis. Hum Pathol 28: 650–656.
Kobashi Y et al., 2006. Chronic necrotizing pulmonary aspergillosis as a complication of pulmonary Mycobacterium avium complex disease. Respirology 11: 809–813.
Hou X et al., 2017. Clinical features and diagnosis of chronic pulmonary aspergillosis in Chinese patients. Medicine (Baltimore) 96: e8315.
Yoon SH et al., 2011. Pulmonary aspergillosis in immunocompetent patients without air-meniscus sign and underlying lung disease: CT findings and histopathologic features. Acta Radiol 52: 756–761.
Lim J et al., 2010. Non-tuberculous mycobacterial diseases presenting as solitary pulmonary nodules. Int J Tuberc Lung Dis 14: 1635–1640.
Baik JJ et al., 1999. Pulmonary actinomycosis in Korea. Respirology 4: 31–35.
McConnochie K et al., 1989. Aspergillus colonization of pulmonary rheumatoid nodule. Respir Med 83: 157–160.
Cavazza A et al., 2003. Fungus colonisation of pulmonary rheumatoid nodule. J Clin Pathol 56: 636–637.
Sehgal IS et al., 2019. Is there an overlap in immune response between allergic bronchopulmonary and chronic pulmonary aspergillosis? J Allergy Clin Immunol Pract 7: 969–974.
De Pauw B et al., 2008. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 46: 1813–1821.
Maghrabi F , Denning DW , 2017. The management of chronic pulmonary aspergillosis: the UK National Aspergillosis Centre approach. Curr Fungal Infect Rep 11: 242–251.
Sehgal IS , Dhooria S , Muthu V , Prasad KT , Agarwal R , 2020. An overview of the available treatments for chronic cavitary pulmonary aspergillosis. Expert Rev Respir Med 14: 715–727.
Muldoon EG , Sharman A , Page I , Bishop P , Denning DW , 2016. Aspergillus nodules; another presentation of chronic pulmonary Aspergillosis. BMC Pulm Med 16: 123.
Al-Shair K , Atherton GT , Harris C , Ratcliffe L , Newton PJ , Denning DW , 2013. Long-term antifungal treatment improves health status in patients with chronic pulmonary aspergillosis: a longitudinal analysis. Clin Infect Dis 57: 828–835.
Sehgal IS , Dhooria S , Muthu V , Prasad KT , Aggarwal AN , Chakrabarti A , Choudhary H , Garg M , Agarwal R , 2022. Efficacy of 12-months oral itraconazole versus 6-months oral itraconazole to prevent relapses of chronic pulmonary aspergillosis: an open-label, randomised controlled trial in India. Lancet Infect Dis 22: 1052–1062.
Bongomin F , Otu A , Harris C , Foden P , Kosmidis C , Denning DW , 2020. Risk factors for relapse of chronic pulmonary aspergillosis after discontinuation of antifungal therapy. Clin Infect Pract 5: 100015.
Godet C et al.; ACHROSCAN Study Group , 2016. CT imaging assessment of response to treatment in chronic pulmonary aspergillosis. Chest 150: 139–147.
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Full Text Views | 522 | 122 | 17 |
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Chronic pulmonary aspergillosis (CPA) is a life-threatening respiratory fungal infection that is almost exclusively seen in patients with preexisting structural lung disease with no or mild immunosuppression. The clinical presentation and imaging findings are varied and often pose a diagnostic challenge; and the disease is often present for a long time before being correctly diagnosed. High-resolution chest computed tomography is the imaging modality of choice because it helps identify various forms of CPA, which can range from a simple aspergilloma and chronic cavitary form, to the subacute invasive and end-stage fibrotic form. The knowledge of the imaging features of this disease cannot be overemphasized because it can assist the clinician in reaching at an early diagnosis and timely initiation of appropriate antifungal therapy, thereby improving patient management and treatment outcome. Moreover, imaging also plays a pivotal role during follow-up in patients of CPA to assess the treatment response. In the current review, we present an illustrative review of radiologic patterns seen in various forms of CPA.
These authors contributed equally to this work.
Authors’ addresses: Mandeep Garg, Harsimran Bhatia, Uma Debi, Nidhi Prabhakar, and Manavjit Singh Sandhu, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India, E-mails: gargmandeep@hotmail.com, harsimranbhatia13@gmail.com, debi_uma@yahoo.co.in, nidhirajpalprabhakar@gmail.com, and manavjitsandhu@yahoo.com. Tany Chandra, Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, New Delhi, India, E-mail: tanychandra2015@gmail.com. Inderpaul Singh Sehgal and Ritesh Agarwal, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India, E-mails: inderpgi@outlook.com and agarwal.ritesh@outlook.in.
Kosmidis C , Denning DW , 2015. The clinical spectrum of pulmonary aspergillosis. Thorax 70: 270–277.
Franquet T , Müller NL , Giménez A , Guembe P , de La Torre J , Bagué S , 2001. Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics 21: 825–837.
Kanj A , Abdallah N , Soubani AO , 2018. The spectrum of pulmonary aspergillosis. Respir Med 141: 121–131.
Smith NL , Denning DW , 2011. Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir J 37: 865–872.
Allwood BW , Byrne A , Meghji J , Rachow A , van der Zalm MM , Schoch OD , 2021. Post-tuberculosis lung disease: clinical review of an under-recognised global challenge. Respiration 100: 751–763.
Phoompoung P , Chayakulkeeree M , 2020. Chronic pulmonary aspergillosis following nontuberculous mycobacterial infections: an emerging disease. J Fungi (Basel) 6: 346.
Van Braeckel E et al., 2022. Treatment outcome definitions in chronic pulmonary aspergillosis: a CPAnet consensus statement. Eur Respir J 2: 2102950.
Schweer KE et al., 2014. Chronic pulmonary aspergillosis. Mycoses 57: 257–270.
Jhun BW et al., 2013. Clinical characteristics and treatment outcomes of chronic pulmonary aspergillosis. Med Mycol 51: 811–817.
Pena TA , Soubani AO , Samavati L , 2011. Aspergillus lung disease in patients with sarcoidosis: a case series and review of the literature. Lung 189: 167–172.
Denning DW et al., 2016. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J 47: 45–68.
Patterson TF et al., 2016. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the infectious diseases society of America. Clin Infect Dis 63: e1–e60.
Ullmann AJ et al., 2018. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect 24: e1–e38.
Sehgal IS , Choudhary H , Dhooria S , Aggarwal AN , Garg M , Chakrabarti A , Agarwal R , 2018. Diagnostic cut-off of Aspergillus fumigatus-specific IgG in the diagnosis of chronic pulmonary aspergillosis. Mycoses 61: 770–776.
Sehgal IS , Dhooria S , Choudhary H , Aggarwal AN , Garg M , Chakrabarti A , Agarwal R , 2019. Utility of serum and bronchoalveolar lavage fluid galactomannan in diagnosis of chronic pulmonary aspergillosis. J Clin Microbiol 27: e01821-18.
Kono Y et al., 2013. The utility of galactomannan antigen in the bronchial washing and serum for diagnosing pulmonary aspergillosis. Respir Med 107: 1094–1100.
Baluku JB , Nuwagira E , Bongomin F , Denning DW , 2021. Pulmonary TB and chronic pulmonary aspergillosis: clinical differences and similarities. Int J Tuberc Lung Dis 25: 537–546.
Denning DW et al., 2018. Case definition of chronic pulmonary aspergillosis in resource-constrained settings. Emerg Infect Dis 24: e171312.
Page ID et al., 2019. Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation. Eur Respir J 53: 1801184.
Perfect JR et al., 2001. The impact of culture isolation of Aspergillus species: a hospital-based survey of aspergillosis. Clin Infect Dis 33: 1824–1833.
Ohba H et al., 2012. Clinical characteristics and prognosis of chronic pulmonary aspergillosis. Respir Med 106: 724–729.
Carlos Severo L , Resin Geyer G , da Silva Porto N , Bernardes Wagner M , Thomaz Londero A , 1997. Pulmonary Aspergillus niger intra-cavitary colonization. Report of 23 cases and a review of the literature. Rev Iberoam Micol 14: 104–110.
Muldoon EG , Strek ME , Patterson KC , 2017. Allergic and noninvasive infectious pulmonary aspergillosis syndromes. Clin Chest Med 38: 521–534.
Singh R , Garg M , Sodhi KS , Prabhakar N , Singh P , Agarwal R , Malhotra P , 2020. Diagnostic accuracy of magnetic resonance imaging in the evaluation of pulmonary infections in immunocompromised patients. Pol J Radiol 85: e53–e61.
Rolle AM et al., 2016. ImmunoPET/MR imaging allows specific detection of Aspergillus fumigatus lung infection in vivo. Proc Natl Acad Sci USA 113: E1026–E1033.
Aquino SL , Lee ST , Warnock ML , Gamsu G , 1994. Pulmonary aspergillosis: imaging findings with pathologic correlation. AJR Am J Roentgenol 163: 811–815.
Gefter WB , 1992. The spectrum of pulmonary aspergillosis. J Thorac Imaging 7: 56–74.
Logan PM , Müller NL , 1996. CT manifestations of pulmonary aspergillosis. Crit Rev Diagn Imaging 37: 1–37.
Fraser RG et al., 1999. Fungal infections. Diagnosis of Diseases of the Chest. Philadelphia, PA: Saunders; 919–945.
Thompson BH et al., 1995. Varied radiologic appearances of pulmonary aspergillosis. Radiographics 15: 1273–1284.
Irwin A , 1967. Radiology of the aspergilloma. Clin Radiol 18: 432–438.
Roberts CM , Citron KM , Strickland B , 1987. Intrathoracic aspergilloma: role of CT in diagnosis and treatment. Radiology 165: 123–128.
Restrepo CS , Katre R , Mumbower A , 2016. Imaging manifestations of thoracic tuberculosis. Radiol Clin 54: 453–473.
Vishak KA et al., 2014. A rare case of calcified pulmonary aspergilloma. Lung India 31: 79–81.
Yeo CD , Baeg MK , Kim JW , 2012. A case of endobronchial aspergilloma presenting as a broncholith. Am J Med Sci 343: 501–503.
Park Y et al., 2007. Pulmonary cavitary mass containing a mural nodule: differential diagnosis between intracavitary aspergilloma and cavitating lung cancer on contrast-enhanced computed tomography. Clin Radiol 62: 227–232.
Greene R , 2005. The radiological spectrum of pulmonary aspergillosis. Med Mycol 43 (Suppl 1 ):S147–S154.
Greene R , 1981. The pulmonary aspergilloses: three distinct entities or a spectrum of disease. Radiology 140: 527–530.
Klein DL , Gamsu G , 1980. Thoracic manifestations of aspergillosis. AJR Am J Roentgenol 134: 543–552.
Gefter WB , 1992. The spectrum of pulmonary aspergillosis. J Thorac Imaging 7: 56–74.
Denning DW et al., 2003. Chronic cavitary and fibrosing pulmonary and pleural aspergillosis: case series, proposed nomenclature change, and review. Clin Infect Dis 37 (Suppl. 3 ):S265–S280.
Wilopo B , Richardson M , Denning D , 2019. Diagnostic aspects of chronic pulmonary aspergillosis: present and new directions. Curr Fungal Infect Rep 13: 292–300.
Godet C et al., 2014. Chronic pulmonary aspergillosis: an update on diagnosis and treatment. Respiration 88: 162–174.
Soubani AO , Chandrasekar PH , 2002. The clinical spectrum of pulmonary aspergillosis. Chest 121: 1988–1999.
Binder RE et al., 1982. Chronic necrotizing pulmonary aspergillosis: a discrete clinical entity. Medicine (Baltimore) 61: 109–124.
Yousem S , 1997. The histological spectrum of chronic necrotizing forms of pulmonary aspergillosis. Hum Pathol 28: 650–656.
Kobashi Y et al., 2006. Chronic necrotizing pulmonary aspergillosis as a complication of pulmonary Mycobacterium avium complex disease. Respirology 11: 809–813.
Hou X et al., 2017. Clinical features and diagnosis of chronic pulmonary aspergillosis in Chinese patients. Medicine (Baltimore) 96: e8315.
Yoon SH et al., 2011. Pulmonary aspergillosis in immunocompetent patients without air-meniscus sign and underlying lung disease: CT findings and histopathologic features. Acta Radiol 52: 756–761.
Lim J et al., 2010. Non-tuberculous mycobacterial diseases presenting as solitary pulmonary nodules. Int J Tuberc Lung Dis 14: 1635–1640.
Baik JJ et al., 1999. Pulmonary actinomycosis in Korea. Respirology 4: 31–35.
McConnochie K et al., 1989. Aspergillus colonization of pulmonary rheumatoid nodule. Respir Med 83: 157–160.
Cavazza A et al., 2003. Fungus colonisation of pulmonary rheumatoid nodule. J Clin Pathol 56: 636–637.
Sehgal IS et al., 2019. Is there an overlap in immune response between allergic bronchopulmonary and chronic pulmonary aspergillosis? J Allergy Clin Immunol Pract 7: 969–974.
De Pauw B et al., 2008. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 46: 1813–1821.
Maghrabi F , Denning DW , 2017. The management of chronic pulmonary aspergillosis: the UK National Aspergillosis Centre approach. Curr Fungal Infect Rep 11: 242–251.
Sehgal IS , Dhooria S , Muthu V , Prasad KT , Agarwal R , 2020. An overview of the available treatments for chronic cavitary pulmonary aspergillosis. Expert Rev Respir Med 14: 715–727.
Muldoon EG , Sharman A , Page I , Bishop P , Denning DW , 2016. Aspergillus nodules; another presentation of chronic pulmonary Aspergillosis. BMC Pulm Med 16: 123.
Al-Shair K , Atherton GT , Harris C , Ratcliffe L , Newton PJ , Denning DW , 2013. Long-term antifungal treatment improves health status in patients with chronic pulmonary aspergillosis: a longitudinal analysis. Clin Infect Dis 57: 828–835.
Sehgal IS , Dhooria S , Muthu V , Prasad KT , Aggarwal AN , Chakrabarti A , Choudhary H , Garg M , Agarwal R , 2022. Efficacy of 12-months oral itraconazole versus 6-months oral itraconazole to prevent relapses of chronic pulmonary aspergillosis: an open-label, randomised controlled trial in India. Lancet Infect Dis 22: 1052–1062.
Bongomin F , Otu A , Harris C , Foden P , Kosmidis C , Denning DW , 2020. Risk factors for relapse of chronic pulmonary aspergillosis after discontinuation of antifungal therapy. Clin Infect Pract 5: 100015.
Godet C et al.; ACHROSCAN Study Group , 2016. CT imaging assessment of response to treatment in chronic pulmonary aspergillosis. Chest 150: 139–147.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 7491 | 2317 | 108 |
Full Text Views | 522 | 122 | 17 |
PDF Downloads | 333 | 33 | 0 |