Терапевтический архив (Jul 2008)
Early computed tomography signs in diagnosis of some pulmonary mycoses in myelotoxic agranulocytosis
Abstract
Aim. To characterize minimal CT signs of initial pulmonary lesion in candidomycosis and invasive aspergillesis of the lungs. Material and methods. A multislice computer tomograph Light Speed+ (GE) was used to examine 67 patients with hematological malignancy in the condition of myelotoxic agranulocytosis (MTA). A CT picture considered as early presentation of fungal lesion of the lungs was seen in 25 (37%) of 67 patients. This diagnosis was made basing on the symptom of bronchiolyte manifesting roentgenologically as a "tree in the kidneys". Results. Eleven (16%) patients in the condition of MTA for 5-7 days had clinical pulmonary symptoms accompanied with fungal lesion of the upper respiratory tract and a positive reaction to mannan, a Candida antigen, signs of diffuse bronchiolyte. In 14 (21%) patients bronchiolyte symptom was detected in some lobules or segments on MTA day 5-12 and was not associated with pulmonary symptoms and an elevated level of Aspergillus antigen - galactomannan in the blood. A "halo" symptom accompanied with a high concentration of Aspergillus antigen was found in 7 (10%) patients untreated with antifungal drugs at the site of local bronchiolitis. Conclusion. A principal differential-diagnostic sign of bronchiolytis in candidomycosis and aspergillesis of the lungs as shown by multislice computed tomography and high resolution computed tomography is the pattern of its distribution. In candidomycosis bronchiolytis is subtotal or total, with small amount of liquid (> 100 ml) in the pleural cavities (37% cases). Invasive aspergillesis of the lungs is characterized by lobular or segmental bronchiolitis.
