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Computed Tomography and Clinical Features of Invasive Pulmonary Aspergillosis in Liver Transplant Recipients

Qin, Jie MD; Meng, Xiaochun MD; Fang, Yuan MD; Xu, Chuan MD; Zhu, Kangshun MD; Wu, Benquan MD; An, Yuling MD; Shan, Hong MD

doi: 10.1097/RTI.0b013e31820bb462
Original Articles

Purpose The aim of this study was to evaluate the computed tomography (CT) and clinical features of invasive pulmonary aspergillosis (IPA) in liver transplant recipients.

Materials and Methods This study included 25 consecutive liver transplant recipients with histologically confirmed IPA after liver transplantation. CT examinations performed for diagnostic evaluation were available for all patients. CT features were retrospectively evaluated by 2 radiologists. Clinical features and the changes in clinical response and CT features after treatment were also evaluated.

Results Three main CT features were identified: nodules 64% (16 of 25), masses 36% (9 of 25), and consolidations in a patchy pattern 20% (5 of 25). A tree-in-bud pattern was found in 12% (3 of 25) of patients. In 8 (32%) of the 25 patients, we found a combination of 2 or more of these signs: 5 (20%) patients presented with concurrent nodules accompanied by patchy consolidations and/or tree-in-bud, and 3 (12%) patients showed masses accompanied by large consolidations. A halo sign was observed in 20 (80%) of the 25 patients. A hypodense sign and cavitary lesions were encountered in 17 (68%) of the 25 patients. Follow-up CT scans after treatment showed improvement in 18 patients, were unchanged in 4 patients, and showed progression in 3 patients. There were 3 aspergillosis-associated deaths during the follow-up period. The onset time of IPA was a median of 31 days after transplantation. The most common symptom at diagnosis was fever (n=19). None of the 25 patients had leukopenia at the time of the diagnosis of IPA.

Conclusions The most common CT features of IPA in liver transplant recipients are multiple nodules with or without halo sign, masses, and consolidations, which usually appear approximately 1 month after transplantation.

*Department of Radiology

Respiratory Department of Internal Medicine

Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

Reprints: Hong Shan, MD, Department of Radiology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China (e-mail:

The authors declare no conflicts of interest.

Both Jie Qin and Xiaochun Meng contributed equally to this work.

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