Common radiological findings in fungal infections in hematological patients – Review
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2nd Department of Radiology, Medical University of Gdansk, Poland
Clinic of Haematology and Transplantology, Medical University of Gdansk, Poland
Submission date: 2016-07-15
Acceptance date: 2016-12-07
Online publication date: 2016-12-28
Publication date: 2020-03-22
Corresponding author
Kaja Klein-Awarjanow   

2nd Department of Radiology, Medical University of Gdansk, Smoluchowskiego 17, 80-952 Gdansk, Poland. Tel.: +48 58 349 36 80; fax: +48 58 349 36 90.
Pol. Ann. Med. 2017;24(2):287-294
Invasive fungal infections are correlated with an increase in mortality rate among hematological patients. A correct diagnosis based on clinical manifestations may be very time consuming, while a delay in an appropriate treatment can have a negative impact on the further course of the disease.

The aim of this study is to present the most common radiological findings seen in CT or MRI which may help in making an accurate diagnosis.

Material and methods:
A thorough literature search concerning the nature of invasive fungal infections, their clinical manifestations and methods of their radiological imaging were reviewed.

An early diagnosis based on radiological imaging is crucial since radiological modalities are able to reveal lesions that can suggest ongoing fungal processes.

There is a relationship between an early diagnosis of fungal lesions in CT imaging (i.e. the halo sign or micro- and macro-nodules) and an increase in the survival rate of hematological patients. Moreover, radiological methods of imaging can determine the degree of severity, especially the invasion of the infection into soft tissues, orbital cavities, brain and vasculature.

Early and systematic radiological assessment of hematological patients with increased risk of fungal infection result in an accurate diagnosis and have a positive impact on the decrease of mortality rate of immunocompromised patients.

None declared.
Pfaller MA, Pappas PG, Wingard JR. Invasive fungal pathogens: current epidemiological trends. Clin Infect Dis. 2006;43(1):S3–S14.
Pagano L, Caira M, Candoni A, et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica. 2006;91(8):1068–1075.
Marr KA, Carter RA, Crippa F, Wald A, Corey L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34(7):909–917.
Pagano L, Caira M, Nosari A, et al. Fungal infections in recipients of hematopoietic stem cell transplants: results of the SEIFEM B-2004 study – Sorveglianza Epidemiologica Infezioni Fungine Nelle Emopatie Maligne. Clin Infect Dis. 2007;45(9):1161–1170.
Lass-Flörl C. The changing face of epidemiology of invasive fungal disease in Europe. Mycoses. 2009;52(3):197–205.
Richardson M, Lass-Flörl C. Changing epidemiology of systemic fungal infections. ClinMicrobiol Infect. 2008;14(suppl 4):5–24.
Kuhlman JE, Fishman EK, Siegelman SS. Invasive pulmonary aspergillosis in acute leukemia: characteristic findings on CT, the CT halo sign, and the role of CT in early diagnosis. Radiology. 1985;157(3):611–614.
Austin JH, Muller NL, Friedman PJ, et al. Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Radiology. 1996;200(2):327–331.
Shibuya K, Ando T, Hasegawa C, et al. Pathophysiology of pulmonary aspergillosis. J Infect Chemother. 2004;10(3):138–145.
Georgiadou SP, Sipsas NV, Marom EM, Kontoyiannis DP. The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts. Clin Infect Dis. 2011;52(9):1144–1155.
Caillot D, Couaillier JF, Bernard A, et al. Increasing volume and changing characteristics of invasive pulmonary aspergillosis on sequential thoracic computed tomography scans in patients with neutropenia. J Clin Oncol. 2001;19(1):253–259.
Greene RE, Schlamm HT, Oestmann JW, et al. Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign. Clin Infect Dis. 2007;44(3):373–379.
Walsh S, Tunnicliffe G. Importance of the reversed halo sign for the diagnosis of angioinvasive pulmonary aspergillosis. Respir Med. 2014;108(8):1240.
Sah SK, Li Y, Ganganah O, Shi X, Li Y. An update of clinical characteristics and imaging findings of pulmonary aspergillosis. Int J Diagn Imaging. 2016;3(1):8–18.
Caillot D, Mannone L, Cuisenier B, Couaillier JF. Role of early diagnosis and aggressive surgery in the management of invasive pulmonary aspergillosis in neutropenic patients. Clin Microbiol Infect. 2001;7(suppl 2):54–61.
Rossi SE, Franquet T, Volpacchio M, Giménez A, Aguilar G. Tree-in-bud pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics. 2005;25(3):789–801.
Khandelwal N, Sodhi KS, Sinha A, et al. Multidetector computed tomography and MR imaging findings in mycotic infections. Radiol Clin North Am. 2016;54(3):503–518.
Talati K, Lee KS. Magnetic resonance imaging of hepatic abscesses. Semin Roentgenol. 2016. Accessed 14.08.16.
Herrera DA, Dublin AB, Ormsby EL, Aminpour S, Howell LP. Imaging findings of rhinocerebral mucormycosis. Skull Base. 2009;19(2):117–125.
De Pauw B,Walsh TJ, Donnelly JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46(12):1813–1821.
Riwes MM, Wingard JR. Diagnostic methods for invasive fungal diseases in patients with hematologic malignancies. Expert Rev Hematol. 2012;5(6):661–669.
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