CTICasesAngioinvasive Aspergillosis with Air Crescent Sign in Neutropenic Patient
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Imaging findings
Initial radiograph showed a pneumonia in the left upper lobe. A CT done a week later (day 0 or 1 of stem cell transplant) showed an area of consolidation within the left upper lobe with significant surrounding ground-glass opacity (Halo sign), likely representing hemorrhagic consolidation with central necrosis. Follow-up CT showed the same area of consolidation, but now with a true air crescent sign.
Key takeaways
This patient with CML underwent a failed and then a second bone marrow transplant. He developed angioinvasive aspergillosis, supported by positive galactomannan tests. After starting antifungals and with recovery of his neutrophil count (from zero to normal), the infection began to wall off, resulting in the classic air crescent sign. Incidental calcified hilar granulomas were noted but considered unrelated to the acute process.
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