Airway-Invasive Aspergillosis: Acute Tracheobronchitis

HomeRadiologyVol. 302, No. 1 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyAirway-Invasive Aspergillosis: Acute TracheobronchitisLucas de Pádua Gomes de Farias , Marcio Valente Yamada SawamuraLucas de Pádua Gomes de Farias , Marcio Valente Yamada SawamuraAuthor AffiliationsFrom the Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos 75, Cerqueira César, São Paulo, SP 05403-010, Brazil.Address correspondence to L.d.P.G.d.F. (e-mail:[email protected]).Lucas de Pádua Gomes de Farias Marcio Valente Yamada SawamuraPublished Online:Oct 19 2021https://doi.org/10.1148/radiol.2021211630MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 68-year-old woman undergoing chemotherapy for Burkitt lymphoma presented with a 3-week history of cough. Her complete blood count was abnormal and showed pancytopenia with a complete white blood cell count of 100/mm3 (normal range, 4000–11 000/mm3). Her chest CT scan was abnormal, and a follow-up fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT examination (Figure, A) showed that the lower third of the tracheal wall was thickened with 18F-FDG uptake (maximum standardized uptake value, 4.4–4.8). A coronal thick-slab inverted minimum intensity projection image of the tracheobronchial tree from the chest CT scan showed multiple areas of tracheobronchial narrowing (Figure, B).Images in 68-year-old woman undergoing chemotherapy for Burkitt lymphoma and complaining of cough. (A) Two-dimensional fluorine 18 (18F) fluorodeoxyglucose PET/CT of distal trachea shows wall thickening (arrow) with 18F-fluorodeoxyglucose uptake (maximum standardized uptake value, 4.4–4.8). (B) Coronal thick-slab inverted minimum intensity projection image from chest CT scan shows multiple areas of tracheobronchial narrowing (arrows). Complete blood count revealed pancytopenia with white blood cell count of 100/mm3. (C) Bronchoscopic image at carina shows tracheal and left main bronchial mucosa hyperemia, edema, and circumferential narrowing. Yellowish plaques with pseudomembranes, ulcerations, and tracheal cartilage exposure (arrow) are shown. Tracheal biopsy results showed airway-invasive aspergillosis and hyphae of Aspergillus fumigatus.Download as PowerPointOpen in Image Viewer Aspergillosis is a very common fungus with a varied histologic, clinical, and radiologic manifestation depending on the number and virulence of the organisms and the patient’s immune response (1). Airway-invasive aspergillosis is defined as infection that is deep to the basement membrane. This is a rare manifestation, which occurs primarily in immunocompromised neutropenic patients (1,2). At chest CT, airway walls may be thickened with luminal narrowing (1,2). Clark et al (3) described two morphologic forms of fungal tracheobronchitis. The first is characterized by intraluminal growth involving the airway with only superficial invasion and ulceration that can appear as a pseudomembrane. The second is more invasive and consists of nodular plaques that can penetrate beyond the tracheobronchial wall to the adjacent tissues.Disclosures of Conflicts of Interest: L.d.P.G.d.F. No relevant relationships. M.V.Y.S. No relevant relationships.References1. Franquet T, Müller NL, Giménez A, Guembe P, de La Torre J, Bagué S. Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. RadioGraphics 2001;21(4):825–837. Link, Google Scholar2. Logan PM, Primack SL, Miller RR, Müller NL. Invasive aspergillosis of the airways: radiographic, CT, and pathologic findings. Radiology 1994;193(2):383–388. Link, Google Scholar3. Clarke A, Skelton J, Fraser RS. Fungal tracheobronchitis. Report of 9 cases and review of the literature. Medicine (Baltimore) 1991;70(1):1–14. Crossref, Medline, Google ScholarArticle HistoryReceived: July 2 2021Revision requested: July 14 2021Revision received: July 15 2021Accepted: July 21 2021Published online: Oct 19 2021Published in print: Jan 2022 FiguresReferencesRelatedDetailsRecommended Articles Cardiopulmonary and Gastrointestinal Manifestations of Eosinophil- associated Diseases and Idiopathic Hypereosinophilic Syndromes: Multimodality Imaging ApproachRadioGraphics2016Volume: 36Issue: 2pp. 433-451Imaging Evaluation of Tracheobronchial InjuriesRadioGraphics2020Volume: 40Issue: 2pp. 515-528Overview of Interventional Pulmonology for RadiologistsRadioGraphics2021Volume: 41Issue: 7pp. 1916-1935Human Oncoviruses and Thoracic Tumors: Understanding the Imaging FindingsRadioGraphics2022Volume: 42Issue: 3pp. 644-660Case 260: Endobronchial Posttransplantation Lymphoproliferative DiseaseRadiology2018Volume: 289Issue: 3pp. 876-880See More RSNA Education Exhibits Taming the Broncho: An Imaging Guide to Acute Bronchial DisordersDigital Posters2022Down the Hatch: A Systematic Approach in Cross-Sectional Evaluation of the TracheaDigital Posters2019Wheezy-breezy? 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