Date: 26 November 2013
Halo sign in IPA
Copyright: n/a
Notes:
CT scan of a neutropenia patient with leukaemia who has 2 lesions. One, on the right, is nodular, abuts on the pleura and is surrounded by a (grey) low attenuation area, referred to as the “halo” sign. This is virtually only seen in invasive fungal infections of the lung, especially early in the course of the disease, during neutropenia. The other lesion visible on this scan, posteriorly on the left, is also typical of invasive pulmonary aspergillosis in that it is pleura-based and has sharply angulated sides typical of vascular invasion and infarction of small lung segments. There is the suggestion of a “halo” sign anteriorly, but there is less confidence in this appearance (compared with the other) because it is only on one side of the lesion.
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This photo shows extensive infection of the burn wound on the leg of a 7 year old boy, acquired about 3 weeks after the injury. Despite medical therapy he died.
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This patient, had had a laparostomy for recurrent intra-abdominal sepsis following on from crohns disease. She was transferred to another intensive care unit and her dressings changed daily. Shortly after, this dark patches appeared on her liver (as seen here A) and her colon. Superficial biopsies and culture showed A.fumigatus invading liver capsule. She responded to amphotericin B therapy.
B shows patient after treatment.
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Hepatic aspergillosis, pt KO. Repeat CT scan of the liver showing almost complete resolution of lesions on itraconazole therapy.
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Image A. The CT scan of her abdomen had the appearances shown here. She also has small pulmonary nodules. Bioposy of the liver revealed hyphae consistent with Aspergillus.
Image B. She responded well to oral itraconazole therapy.
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This image shows the pelvis of the left kidney filled with fungal balls. Eventually, after failing amphotericin B therapy, she required a nephrectomy. Her case is reported in Davies SP, Webb WJS, Patou G, Murray WK, Denning DW. Renal aspergilloma – a case illustrating the problems of medical therapy. Nephrol Dial Transplant 1987; 2: 568-572.
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Aspergillus keratitis. Good example of Aspergillus keratitis caused by A.glaucus. Usually A.fumitagus and A.flavus are the causes.
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