Invasive pulmonary aspergillosis in heart transplant recipients: two radiologic patterns with a different prognosis

J Heart Lung Transplant. 2014 Oct;33(10):1034-40. doi: 10.1016/j.healun.2014.05.003. Epub 2014 Jun 2.


Background: Computed tomography (CT) findings can be used to classify invasive pulmonary aspergillosis (IPA) in 2 patterns: airway-invasive (AIR) or angioinvasive (ANG).

Methods: AIR-IPA was considered when the CT revealed peribronchial consolidation or a tree-in-bud pattern and ANG-IPA when a nodule, cavity, halo sign, infarct-shaped, or mass-like consolidation was found. We evaluated the correlation among IPA patterns on CT and outcomes in heart transplant (HT) recipients.

Results: The study included 27 HT recipients with a CT scan performed at the time of IPA diagnosis. The study interval was from 1988 to 2011. Ten AIR-IPA patients (37.1%) were compared with 17 ANG-IPA patients (62.9%). During the post-transplantation period before IPA developed, AIR patients required hemodialysis more frequently (40% vs 5.9%, p = 0.04). AIR patients also had more intercurrent bacterial pneumonia (23.5% vs 70%, p < 0.001), and IPA was diagnosed later after onset of symptoms (2.7 vs 8.5 d, p = 0.09). After diagnosis, AIR-IPA patients required more mechanical ventilation (23.5% vs 90%, p < 0.01) and had a higher related mortality rate (23.5% vs 70%, p = 0.04).

Conclusions: Our study shows that the AIR pattern represents 37% of IPA episodes in HT recipients and is associated with a more protracted clinical presentation, later diagnosis, and higher mortality rate.

Keywords: Aspergillus spp; airway-invasive pattern; angio-invasive pattern; heart transplant; invasive aspergillosis.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antifungal Agents / therapeutic use
  • Female
  • Heart / diagnostic imaging*
  • Heart / microbiology
  • Heart Transplantation / adverse effects*
  • Humans
  • Immunocompromised Host
  • Invasive Pulmonary Aspergillosis / diagnosis*
  • Invasive Pulmonary Aspergillosis / diagnostic imaging*
  • Invasive Pulmonary Aspergillosis / mortality
  • Lung / diagnostic imaging*
  • Lung / microbiology
  • Male
  • Middle Aged
  • Prognosis
  • Respiration, Artificial
  • Retrospective Studies
  • Survival Rate
  • Tomography, X-Ray Computed
  • Transplant Recipients*


  • Antifungal Agents