HRCT imaging findings and dynamic changes of invasive pulmonary aspergillosis

Objective To investigate HRCT image findings of Invasive Pulmonary Aspergillosis (IPA) and the dynamic changes of the image before and after treatment. Methods Clinical data of 56 patients with invasive pulmonary aspergillosis confirmed by sputum culture or histopathological examination in our hospital from January 2014 to December 2017 were retrospectively analyzed. To investigate the HRCT findings of IPA and the dynamic changes of CT before and after anti-fungal therapy. Results In this group, 42 cases (75.0%) presented as patch shadow, 33 cases (58.9%) presented as pulmonary nodules, and 23 cases (23/33, 69.7%) presented as nodules with "halo" sign, 15 cases (26.8%) had "Air Crescent", 9 cases (9/15, 60%) occurred in about 3 th week. After anti-fungal therapy, the imaging changes of the clinical symptoms improvement group and the unimproved group at 1 th-4 th week after anti-fungal treatment were 0.162, 0.289, 0.010, 0.006, 29 cases (29/38, 76.3%) of the 4 groups with improved clinical symptoms presented imaging progression at 2 th week, among the 29 patients, there were 15 cases (15/29, 51.7%) with puncture gas shadow, after further treatment, the point gas will form typical "Air Crescent" signs or disappear. Conclusion Typical HRCT images of IPA showed single or multiple plaques, nodules, aspergilloma and "Air Crescent" in the lungs, while the occurrence of nodules and air crescent highly suggest IPA, most of "Air Crescent" occurred in about 3 th week, which prompts terminal IPA. CT examination is recommended at 3 th and 4 th week after anti-fungal therapy. About the 2 th week after anti-fungal therapy, the volume or number of pulmonary lesions will increase, and the puncture gas shadow will appear, at this point, the efficacy of anti-fungal therapy should be evaluated in combination with clinical objective evaluation.