Airway invasive aspergillosis
Airway invasive aspergillosis refers to a form of invasive aspergillosis that affects the airways as the major or only feature.
It usually occurs in immunocompromised neutropenic patients, particularly AIDS patients. Aspergillosis affecting the airways as the major or only feature of the invasive disease is uncommon and is thought to occur in only around 7% of cases of intrathoracic aspergillosis 3.
Clinical manifestations can vary and range from an acute tracheobronchitis, to bronchiolitis to bronchopneumonia.
It is histologically characterised by the presence of Aspergillus organisms deep to the airway basement membrane 1.
Two morphological forms of invasive aspergillosis of the trachea and bronchi have been described 3 :
- intraluminal: circumferential and superficial “pseudomembrane” of necrotic tissue, fibrin and hyphae, which may result in airway occlusion
- multiple nodular plaques: invades adjacent tissues and may lead to broncho-oesophageal and fatal haemorrhage from bronchoarterial fistulation
The imaging spectrum is variable, depending on whether is it an obstructive tracheobronchitis, bronchiolitis or bronchopneumonia:
obstructive tracheobronchitis due to aspergillosis
- most have normal radiographic findings in the acute phase
- occasionally, tracheal or bronchial wall thickening may be seen
- aspergillus bronchiolitis
- typically seen as predominantly peribronchial areas of consolidation
- rarely, there can be lobar consolidation
- it is almost impossible to differentiate aspergillus bronchopneumonia from bronchopneumonia due to other causes
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