Computerized tomography diagnosis of pulmonary fungal infection in patients with acute leukemia after chemotherapy

To explore computerized tomography (CT) imaging features of pulmonary fungal infection (PFI) in patients with acute leukemia (AL) after chemotherapy.

Totally 116 AL patients who received chemotherapy in our hospital from June 2016 to April 2023 participated into this study, and the pulmonary fungal infection was confirmed by laboratory examination and clinical antifungal treatment. The CT image signs, lesion distribution, CT concomitant signs and main types of fungal infection were analyzed.

CT image signs of two main types, nodule/mass type and mixed type were recorded, with76 cases of nodular/mass type and 40 cases of mixed type. There were 372 lesions in nodules/mass cases, mainly in the upper lung (46.24%). In these 372 lesions, 113 micro-tubercle, 138 small nodules, 115 nodules and 6 masses were included. There were 88 cases of halo sign, 26 cases of cavity, and 25 cases of air crescent sign. Candida albicans was the most common pathogenic fungal strain, followed by aspergillus, candida tropicalis, candida glabrata, candida parapsilosis, cryptococcus, candida dubliniensis, mucor, candida krusei and candida rugosa.

The CT manifestations of AL complicated with pulmonary fungal infection after chemotherapy were various, most of which had no characteristics, but the “halo sign” and “air crescent sign” had certain specificity. The combined CT and clinical manifestations can narrow the range of differential diagnosis. When the diagnosis still cannot be confirmed, diagnostic therapy or early diagnosis by fungal culture and histological examination can be performed.