Evaluating Pulmonary Nodules in Neutropenic Febrile Patients

DORA HO, MD, PhD, MARGARET LIN, MD, FERNANDO ROSSO, MD, ANN LEUNG, MD, STEVEN COUTRE, MD, JOSE MONTOYA, MD;

Author address: 

Stanford University School of Medicine, Stanford, CA.

Abstract: 

Background: Patients (pts) with hematologic malignancies frequently develop severe infections as they become neutropenic from chemotherapy. During their neutropenic febrile episodes, their chest CTs not uncommonly reveal nodular opacities, which may suggest invasive fungal disease. We aim to systematically study the significance of such nodules to understand their etiologies and to improve treatment outcome. Methods: From 1994 to 2005, we identified 1291 pts with hematologic malignancies who developed neutropenic fever after chemotherapy. Chest CTs were performed in 289 pts. Data from 87 patients with abnormal CTs were further analyzed. Results: Among these 87 pts, 18 and 9 pts had proven and probable fungal infections (as defined in Clin Infect Dis 34:7), respectively. Diagnostic procedures were done in 61 pts, which include 37 bronchoscopies, 22 lung biopsies and 6 sinus biopsies, with a diagnostic yield of 13.5%, 41% and 67%, respectively. Detailed analysis of 173 CTs from 56 pts has been completed. On initial CTs, 32% of pts had consolidations, 89% had lung nodules and 46% had pleural effusions. Only 22% of the nodules had the halo sign and 14% had cavities. Of those with proven or probable fungal infections, 87% had nodules, 29% had nodules with a halo and 100% had nodules of 6mm in majority. For those without proven or probable fungal infections (n = 60), a similar % of pts had nodules and halo, but 30% had nodules
2006

abstract No: 

555

Full conference title: 

Infectious Diseases Society of America, 44th Annual Meeting
    • IDSA 44th