Alamo Leonor, Ceppi Francesco, Tenisch Estelle, Beigelman-Aubry Catherine
Department of Radiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
University of Lausanne (UNIL), Lausanne, Switzerland.
Insights Imaging. 2024 Dec 12;15(1):296. doi: 10.1186/s13244-024-01871-w.
Hemato-oncologic children form a heterogeneous group with a wide spectrum of ages, malignancy types, and immunosuppression grades during the different phases of their treatment. Immunosuppression is caused by multiple factors, including the malignancy itself, bone marrow suppression secondary to therapy, and wide use of steroids and antibiotics, among others. At the same time, the risk of infections in these patients remains high because of prolonged hospitalizations or the need for long-timing implanted devices between other features. In this context, a pulmonary fungal infection can rapidly turn into a life-threatening condition that requires early diagnosis and appropriate management. This pictorial essay illustrates the main imaging findings detected in chest computed tomography examinations performed in pediatric hemato-oncologic patients with proven pulmonary invasive fungal infections caused by Candida, Aspergillus, or Mucor. In addition, it describes useful clues for limiting differential diagnoses, reviews the literature on pediatric patients, and compares imaging findings in adults and children. CRITICAL RELEVANCE STATEMENT: The main fungal pathogens causing invasive fungal infections (IFI) in hemato-oncologic children are Candida, Aspergillus, and Mucor. This review describes the most frequently affected organs and the most common imaging findings detected in chest CT exams in children with pulmonary IFI. KEY POINTS: To review the main computed tomography imaging findings suggesting pulmonary invasive fungal infection (IFI) in hemato-oncologic children. To describe differences between pediatric and adult patients with proven pulmonary IFI. To provide useful clues for limiting the differential diagnosis of pulmonary IFI in pediatric patients.
血液肿瘤患儿是一个异质性群体，在治疗的不同阶段，他们的年龄范围、恶性肿瘤类型和免疫抑制程度各不相同。免疫抑制由多种因素引起，包括恶性肿瘤本身、治疗引起的骨髓抑制以及类固醇和抗生素的广泛使用等。与此同时，由于住院时间延长或需要长期植入装置等其他因素，这些患者的感染风险仍然很高。在这种情况下，肺部真菌感染可迅速发展为危及生命的疾病，需要早期诊断和适当治疗。这篇图文并茂的文章阐述了在胸部计算机断层扫描检查中发现的主要影像学表现，这些检查针对的是经证实由念珠菌、曲霉菌或毛霉菌引起肺部侵袭性真菌感染的儿科血液肿瘤患者。此外，文章还描述了有助于限制鉴别诊断的有用线索，回顾了关于儿科患者的文献，并比较了成人和儿童的影像学表现。关键相关性声明：导致血液肿瘤患儿侵袭性真菌感染（IFI）的主要真菌病原体是念珠菌、曲霉菌和毛霉菌。本综述描述了肺部IFI患儿胸部CT检查中最常受累的器官和最常见的影像学表现。要点：回顾提示血液肿瘤患儿肺部侵袭性真菌感染（IFI）的主要计算机断层扫描影像学表现。描述确诊为肺部IFI的儿科和成人患者之间的差异。为限制儿科患者肺部IFI的鉴别诊断提供有用线索。
