CTICasesAngioinvasive Aspergillosis
Imaging findings
Serial chest CT scans in a neutropenic myeloma patient show a consolidative lesion in the right lung containing an air-crescent sign, representing a healing fungal infection. Concurrently, a new consolidative lesion has developed in the left lung with a 'reverse halo' or 'bird's nest' sign. Bronchoscopy yields acute-angle branching septate hyphae, consistent with Aspergillus.
Key takeaways
Angioinvasive aspergillosis is a life-threatening opportunistic fungal infection in neutropenic patients. The classic CT stages include a halo sign (infarction with surrounding hemorrhage) which progresses to an air-crescent sign (representing necrotic lung retraction during neutrophil recovery). Relapse of neutropenia can trigger a new, coexistent infection showing early signs like the reverse halo sign.
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