CTICasesSemi-Invasive Aspergillosis
Imaging findings
Serial chest CT scans in a patient with a history of mantle radiation therapy for lymphoma show bilateral apical radiation fibrosis and volume loss. Within these areas of damaged lung, there are progressive low-attenuation necrotizing consolidation and cavity formation, developing into bilateral fungus balls with characteristic air-crescent signs (Monod sign), confirmed to represent chronic semi-invasive aspergillosis.
Key takeaways
Semi-invasive (chronic necrotizing) aspergillosis is a subacute opportunistic fungal infection that typically affects mildly immunocompromised patients or those with pre-existing damaged lung tissue (such as radiation fibrosis, sarcoidosis, or COPD). Aspergillus slowly invades the damaged lung tissue, causing necrosis and cavitation, which eventually leads to mycetoma (fungus ball) formation within the cavity. Management is difficult and requires long-term antifungal therapy.
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See all cases from January 21, 2018 →