Imaging findings of multislice computed tomography in 21 patients with airway invasive pulmonary aspergillosis.

Background: Airway invasive aspergillosis (AWIA) poses a diagnostic challenge due to its nonspecific clinical manifestations. This study aimed to characterize the imaging findings of AWIA and explore the clinical characteristics that facilitate the diagnosis of AWIA. Methods: A retrospective analysis was conducted on 21 patients clinically and pathologically diagnosed with AWIA. All subjects underwent chest multislice computed tomography (MSCT) scans, and their clinical data were collected. The computed tomography (CT) features were evaluated, and 17 patients received the follow-up of MSCT in our hospital. Results: The high-frequency CT signs with an incidence of ≥60% included lobar and segmental bronchial lumen stenosis and wall thickening, patchy peribronchial consolidation, tree-in-bud sign, nodules (>5 mm), bronchioles wall thickening and lumen expansion. The low-frequency signs with an incidence of <40% included trachea or left/right main bronchial wall thickening, lobar and segmental bronchiectasis and wall thickening, ground-glass opacity, cavity, and pleural effusion. The inter-reader agreement for CT features was substantial (kappa =0.78). Additionally, we observed that clinical symptom improvement did not always correspond with immediate improvement in CT imaging findings during the early stages of treatment. Conclusions: The presence of specific high-frequency CT features in patients with underlying risk factors should prompt consideration of AWIA. Early recognition of these CT patterns may facilitate timely diagnosis and treatment, potentially improving patient outcomes.