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Semiinvasive Pulmonary Aspergillosis in Chronic Obstructive Pulmonary Disease

Radiologic and Pathologic Findings in Nine Patients

¹ Department of Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, San Antonio M. Claret 167, 08025 Barcelona, Spain.
² Department of Radiology, University of British Columbia and Vancouver Hospital and Health Sciences Centre, 855 W. 12th Ave., Vancouver, British Columbia, V5Z 1M9 Canada.
³ Department of Internal Medicine, Hospital de Sant Pau, Universidad Autónoma de Barcelona, 08025, Barcelona, Spain.
⁴ Department of Pathology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, 08025, Barcelona, Spain.

OBJECTIVE. The purpose of this study is to assess the radiographic, thin-section CT, and histologic findings of semiinvasive aspergillosis in patients with chronic obstructive pulmonary disease (COPD).

MATERIALS AND METHODS. The study included nine patients with COPD seen at the Hospital de Sant Pau during a 3-year period who had histopathologically proven aspergillosis with tissue invasion. Chest radiography and thin-section (2-mm collimation) CT of the chest were available in all cases.

RESULTS. Nine patients had semiinvasive aspergillosis proven at autopsy (n = 7) or by thoracoscopically guided lung biopsy (n = 2). The radiologic findings consisted of parenchymal consolidation (n = 6) and nodules larger than 1 cm in diameter (n = 3). Parenchymal consolidation involved the upper lobes in five patients and was bilateral in four. Cavitation was present in two of the patients with consolidation and in two of the patients with nodular opacities. Adjacent pleural thickening was revealed by CT in four patients. Histologically, the areas of consolidation represented active inflammation and intraalveolar hemorrhage containing Aspergillus organisms. In the three patients with multiple cavitated nodules, a variable degree of central necrosis was observed. The inflammatory infiltrate extended into the surrounding lung parenchyma, and adjacent areas of hemorrhage were also seen. Aspergillus colonies were identified within the lung tissue.

CONCLUSION. Upper lobe consolidation or multiple nodules in patients with COPD should raise the possibility of semiinvasive aspergillosis.

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