CTICasesAngioinvasive Aspergillosis ("Bird's Nest" Sign)
Imaging findings
In a neutropenic patient with a nodular chest radiograph opacity, CT shows a rounded lesion with central low attenuation surrounded by a halo and reversed-halo appearance -- the "bird's nest" sign -- plus several smaller nodules with halos in other lobes; the dominant lesion crosses the minor fissure to involve both the right upper and middle lobes.
Key takeaways
The bird's-nest sign of a central lucent focus within a halo/reversed-halo nodule is classically associated with angioinvasive fungal infection, most often mucormycosis, but here bronchoscopy with PCR and galactomannan testing confirmed Aspergillus instead -- a reminder that the sign is not organism-specific, and multiple concurrent nodules can favor Aspergillus over mucormycosis.
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