Document Detail

Invasive pulmonary aspergillosis: frequency and meaning of the "hypodense sign" on unenhanced CT.
MedLine Citation:
PMID:  16046420     Owner:  NLM     Status:  MEDLINE    
The purpose of this study was to establish the diagnostic value of central hypointensity ("hypodense sign") in lung consolidations or nodules, in severely immunocompromised or neutropenic patients, suspected of having invasive pulmonary aspergillosis (IPA), and to assess its recognition on unenhanced CT scans. Serial CT scans of the lung were retrospectively reviewed in 43 consecutive immunosuppressed patients with IPA, and assessed for the presence of the hypodense sign using standard mediastinal and lung windowing settings, as well as a special, narrower window setting (width 110-140 HU; level 15-40 HU). The temporal relationship between the occurrence of the first CT-finding suspicious of IPA and the appearance of the hypodense sign, as well as between this and the occurrence of the crescent sign, cavitation or reduction in lesion size, was evaluated. Additionally, CT-scans from 89 immunocompromised patients with viral (n=45) or bacterial (n=44) pneumonia, investigated in the same time period at our institution were reviewed, with respect to the presence of the "hypodense" sign. Unenhanced CT scans revealed the hypodense sign in 11 neutropenic patients and 2 severely immunocompromised patients, out of a total of 43 patients with IPA evaluated in this study (30.2%). The mean time between the appearance of the first CT-findings of IPA (large nodule or consolidation +/- positive halo sign) and the hypodense sign was 7.8 days, while the time interval between the hypodense sign and the occurrence of crescent sign, cavitation, or decrease of the lesion's size was 8.3 days. The hypodense sign did not occur in any of the patients with viral or bacterial pneumonia, in the control series. We consider the hypodense sign to be a supplementary tool in the diagnosis of IPA. Its sensitivity was low in our series, but the high specificity makes it valuable in predicting IPA, anticipating the occurrence of cavitation or crescent sign, which are considered specific, but late findings of IPA. The hypodense sign is recognizable also on unenhanced CT, when a narrower lung window setting is used.
M Horger; H Einsele; U Schumacher; M Wehrmann; H Hebart; C Lengerke; R Vonthein; C D Claussen; C Pfannenberg
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The British journal of radiology     Volume:  78     ISSN:  0007-1285     ISO Abbreviation:  Br J Radiol     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-07-27     Completed Date:  2005-09-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0373125     Medline TA:  Br J Radiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  697-703     Citation Subset:  AIM; IM    
Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076 Tübingen.
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MeSH Terms
Antifungal Agents / therapeutic use
Aspergillosis / complications,  drug therapy,  radiography*
Bone Marrow Transplantation
Immunocompromised Host
Immunosuppressive Agents / therapeutic use
Lung / radiography
Lung Diseases, Fungal / complications,  drug therapy,  radiography*
Middle Aged
Neutropenia / complications,  radiography
Pneumonia, Bacterial / radiography
Pneumonia, Viral / radiography
Retrospective Studies
Time Factors
Tomography, X-Ray Computed / methods*
Reg. No./Substance:
0/Antifungal Agents; 0/Immunosuppressive Agents

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