Clin Imaging . CT findings of COVID-19-associated pulmonary aspergillosis: a systematic review and individual patient data analysis

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Clin Imaging


. 2022 Jul 23;90:11-18.
doi: 10.1016/j.clinimag.2022.07.003. Online ahead of print.
CT findings of COVID-19-associated pulmonary aspergillosis: a systematic review and individual patient data analysis


Wonju Hong ¹ , P Lewis White ² , Matthijs Backx ² , Jean-Pierre Gangneux ³ , Florian Reizine ⁴ , Philipp Koehler ⁵ , Robbert G Bentvelsen ⁶ , María Luján Cuestas ⁷ , Hamed Fakhim ⁸ , Jung Im Jung ⁹ , Young Kyung Lee ¹⁰ , Nishil R Dalsania ¹¹ , Ravi Karan Patti ¹¹ , Soon Ho Yoon ¹²



Affiliations

• PMID: 35908455
• DOI: 10.1016/j.clinimag.2022.07.003

Abstract

Purpose: Common CT abnormalities of pulmonary aspergillosis represent a cavity with air-meniscus sign, nodule, mass, and consolidation having an angio-invasive pattern. This study aims to conduct a systematic review and an individual patient-level image analysis of CT findings of COVID-19-associated pulmonary aspergillosis (CAPA).
Methods: A systematic literature search was conducted to identify studies reporting CT findings of CAPA as of January 7, 2021. We summarized study-level clinical and CT findings of CAPA and collected individual patient CT images by inviting corresponding authors. The CT findings were categorized into four groups: group 1, typical appearance of COVID-19; group 2, indeterminate appearance of COVID-19; group 3, atypical for COVID-19 without cavities; and group 4, atypical for COVID-19 with cavities. In group 2, cases had only minor discrepant findings including solid nodules, isolated airspace consolidation with negligible ground-glass opacities, centrilobular micronodules, bronchial abnormalities, and cavities.
Results: The literature search identified 89 patients from 25 studies, and we collected CT images from 35 CAPA patients (mean age 62.4 ± 14.6 years; 21 men): group 1, thirteen patients (37.1%); group 2, eight patients (22.9%); group 3, six patients (17.1%); and group 4, eight patients (22.9%). Eight of the 14 patients (57.1%) with an atypical appearance had bronchial abnormalities, whereas only one (7.1%) had an angio-invasive fungal pattern. In the study-level analysis, cavities were reported in 12 of 54 patients (22.2%).
Conclusion: CAPA can frequently manifest as COVID-19 pneumonia without common CT abnormalities of pulmonary aspergillosis. If abnormalities exist on CT images, CAPA may frequently accompany bronchial abnormalities.

Keywords: Aspergillosis; COVID-19; Coronavirus 2019; Tomography,; X-ray computed.