Atypical imaging patterns during lung invasive mould diseases: lessons for clinicians

Alessio Casutt; Frédéric Lamoth; Olivier Lortholary; John O Prior; Andrea Tonglet; Oriol Manuel; Anne Bergeron; Catherine Beigelman-Aubry

doi:10.1183/16000617.0086-2023

Atypical imaging patterns during lung invasive mould diseases: lessons for clinicians

Eur Respir Rev. 2023 Sep 27;32(169):230086. doi: 10.1183/16000617.0086-2023. Print 2023 Sep 30.

Authors

Alessio Casutt^{1

2}, Frédéric Lamoth^{3

4}, Olivier Lortholary^{5

6}, John O Prior⁷, Andrea Tonglet⁸, Oriol Manuel^{3

9}, Anne Bergeron^{10

11}, Catherine Beigelman-Aubry^{8

11}

Affiliations

¹ Division of Pulmonology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland alessio.casutt@chuv.ch.
² Division of Pulmonology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.
³ Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
⁴ Institute of Microbiology, Department of Laboratories, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
⁵ University Paris Cité, Necker Enfants Malades University Hospital, AP-HP, IHU Imagine, Paris, France.
⁶ Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Paris, France.
⁷ Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
⁸ Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
⁹ Transplantation Center, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
¹⁰ Department of Pulmonology, Geneva University Hospital, University of Geneva, Geneva, Switzerland.
¹¹ A. Bergeron and C. Beigelman-Aubry contributed equally to this work.

Abstract

Imaging of pulmonary invasive mould diseases (IMDs), which represents a cornerstone in their work-up, is mainly based on computed tomography (CT). The purpose of this review is to discuss their CT features, mainly those related to aspergillosis and mucormycosis. We will especially focus on atypical radiological presentations that are increasingly observed among non-neutropenic emerging populations of patients at risk, such as those receiving novel anticancer therapies or those in the intensive care unit. We will also discuss the interest of other available imaging techniques, mainly positron emission tomography/CT, that may play a role in the diagnosis as well as evaluation of disease extent and follow-up. We will show that any new airway-centred abnormality or caveated lesion should evoke IMDs in mildly immunocompromised hosts. Limitations in their recognition may be due to potential underlying abnormalities that increase the complexity of interpretation of lung imaging, as well as the non-specificity of imaging features. In this way, the differentials of all morphological/metabolic aspects must be kept in mind for the optimal management of patients, as well as the benefit of evaluation of the vascular status.

Publication types

Review