Infect Chemother.  2019 Dec;51(4):386-392. 10.3947/ic.2019.51.4.386.

Lung Ultrasound to Evaluate Invasive Fungal Diseases after Allogeneic Hematopoietic Stem Cell Transplantation

• Raffaella
• Lorenzo L
• Elisabetta X
• Andrea A
• Sarah M
• Fabio G
• Daniela C
• Maria Teresa LS
• Consuelo C
• Massimo B
• Fabio C
• Jacopo P

• KMID: 2466471
• DOI: http://doi.org/10.3947/ic.2019.51.4.386

Abstract

Invasive fungal diseases (IFDs) are a leading cause of infection-related-mortality after allogeneic hematopoietic stem cell transplantation (HSCT). In this prospective pilot study, we investigated the use of bedside lung ultrasound (US) in IFD management. Ten consecutive hematological patients, who developed pulmonary IFD after HSCT, were included in the study. Standard computed tomography scan and lung US were performed at IFD diagnosis and 10 days after antifungal treatment. The lung US demonstrated a high sensitivity in the detection of lung lesions at IFD diagnosis and in the follow-up examinations. It is of potential clinical relevance for IFD management in hematological patients.

Keyword

Allogeneic hematopoietic stem cell transplantation; Invasive fungal disease; Ultrasound

MeSH Terms

Diagnosis
Follow-Up Studies
Hematopoietic Stem Cell Transplantation*
Hematopoietic Stem Cells*
Humans
Lung*
Pilot Projects
Prospective Studies
Ultrasonography*

Figure

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  Figure 1 Lung ultrasound images and concomitant computed tomography scan images (UPN 7, UPN 8, and UPN 9). (A) Evidence of a consolidated hypoechoic area with positive air bronchogram in the right medium lobe; presence of a contiguous moderate pleural effusion (patient UPN 7). (A′) Nodular lesion in the medium right lobe and pleural effusion (right > left; patient UPN 7). (B) A consolidated hypoechoic area in the left superior lobe with pleural line attenuation corresponding to the affected area (patient UPN 8). (B′) Nodular lesion in the left superior lobe (partial cavity inside: air crescent sign) and a smaller nodular lesion in the right superior lobe (patient UPN 8). (C) Presence of small consolidated hypoechoic areas with positive air bronchogram sign and contiguous focal B lines in the left inferior lobe (patient UPN 9). (C′) Bilateral nodular ground-glass lesions (inferior lobes; patient UPN 9).

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  Figure 2 Lung ultrasound images and concomitant computed tomography scan images (UPN 2, UPN 3, and UPN 10). (D) Evidence of a small consolidated hypoechoic area in the left superior lobe with pleural line attenuation corresponding to the affected area (patient UPN 2). (D′) Nodular lesion in the superior left lobe (cavity inside; patient UPN 2). (E) One nodular cavitary lesion in the inferior left lobe (patient UPN 3). (E′) Two consolidated hypoechoic areas in the inferior left lobe (patient UPN 3). (F) Bilateral nodular ground-glass lesions (left > right; patient UPN 10). (F′) A scan taken 10 days after the start of antifungal treatment showed smaller consolidated hypoechoic areas in the left inferior lobe and reduction of pleural effusion in comparison to the examination at diagnosis (patient UPN 10).

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