COMPUTED TOMOGRAPHY ASSESSMENT OF PULMONARY ASPERGILLOSIS: IMAGING PHENOTYPES AND DIAGNOSTIC CORRELATION IN A MACEDONIAN CLINICAL COHORT
Keywords:
pulmonary aspergillosis, computed tomography, aspergilloma, chronic cavitary disease, invasive fungal infectionAbstract
Pulmonary aspergillosis comprises a diverse set of fungal disorders with radiologic features influenced by immune status and pre-existing pulmonary architecture. In clinical scenarios where tuberculosis-related structural damage and chronic immunosuppression coexist, computed tomography (CT) plays a central role in raising early diagnostic suspicion and guiding further evaluation. This article presents a single-centre clinical-imaging analysis of patients with confirmed pulmonary aspergillosis managed at a tertiary radiology institution in North Macedonia, with particular focus on CT phenotypes and their diagnostic relevance. Distinct imaging patterns were observed across the cohort, including intracavitary fungal colonization within chronic post-tuberculous cavities, progressive cavitary and paracavitary changes suggestive of semi-invasive disease, and nodular or halo-type lesions correlating with angioinvasion in immunocompromised individuals. CT-based pattern recognition enabled stratification of cases along a spectrum ranging from saprophytic colonization to invasive fungal infection, facilitating targeted microbiologic testing and interventional procedures. Beyond individual diagnostic utility, these findings highlight the broader significance of local epidemiology, as structurally altered lungs provided a permissive substrate for colonization in the majority of patients. Recognition of such CT phenotypes may improve diagnostic confidence, reduce delays in antifungal therapy, and support multidisciplinary management in regions where fungal disease overlaps with chronic pulmonary pathology
References
Alexander, B. D., Lamoth, F., Heussel, C. P., Prokop, C. S., Desai, S. R., Morrissey, C. O., & Baddley, J. W. (2021).
Guidance on Imaging for Invasive Pulmonary Aspergillosis and Mucormycosis: From the Imaging Working Group for the Revision and Update of the Consensus Definitions of Fungal Disease from the EORTC/MSGERC. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 72(Suppl 2), S79–S88. https://doi.org/10.1093/cid/ciaa1855
Aquino, V. R., Nagel, F., Andreolla, H. F., de-Paris, F., Xavier, M. O., Goldani, L. Z., Denning, D. W., &
Pasqualotto, A. C. (2012). The performance of real-time PCR, galactomannan, and fungal culture in the diagnosis of invasive aspergillosis in ventilated patients with chronic obstructive pulmonary disease (COPD). Mycopathologia, 174(2), 163–169. https://doi.org/10.1007/s11046-012-9531-1
Barac, A., Vujovic, A., Drazic, A., Stevanovic, G., Paglietti, B., Lukic, K., Stojanovic, M., & Stjepanovic, M.
(2023). Diagnosis of Chronic Pulmonary Aspergillosis: Clinical, Radiological or Laboratory?. Journal of fungi (Basel, Switzerland), 9(11), 1084. https://doi.org/10.3390/jof9111084
Davda, S., Kowa, X. Y., Aziz, Z., Ellis, S., Cheasty, E., Cappocci, S., & Balan, A. (2018). The development of
pulmonary aspergillosis and its histologic, clinical, and radiologic manifestations. Clinical radiology, 73(11), 913–921. https://doi.org/10.1016/j.crad.2018.06.017
Garg, M., Bhatia, H., Chandra, T., Debi, U., Sehgal, I. S., Prabhakar, N., Sandhu, M. S., & Agarwal, R. (2022).
Imaging Spectrum in Chronic Pulmonary Aspergillosis. The American journal of tropical medicine and hygiene, 108(1), 15–21. https://doi.org/10.4269/ajtmh.22-0366
Garg, A., Bhalla, A. S., Naranje, P., Vyas, S., & Garg, M. (2023). Decoding the Guidelines of Invasive Pulmonary
Aspergillosis in Critical Care Setting: Imaging Perspective. The Indian journal of radiology & imaging, 33(3), 382–391. https://doi.org/10.1055/s-0043-57004
Kang, E. Y., Kim, D. H., Woo, O. H., Choi, J. A., Oh, Y. W., & Kim, C. H. (2002). Pulmonary aspergillosis in
immunocompetent hosts without underlying lesions of the lung: radiologic and pathologic findings. AJR. American journal of roentgenology, 178(6), 1395–1399. https://doi.org/10.2214/ajr.178.6.1781395
Madden, A. E., Ofori, S. K., Budu, M., Sisay, E., Dooley, B., & Murray, M. B. (2025). A Systematic Review of
Chronic Pulmonary Aspergillosis Among Patients Treated for Pulmonary Tuberculosis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 81(4), e163–e171. https://doi.org/10.1093/cid/ciaf150
Nguyen, N. T. B., Le Ngoc, H., Nguyen, N. V., Dinh, L. V., Nguyen, H. V., Nguyen, H. T., & Denning, D. W.
(2021). Chronic Pulmonary Aspergillosis Situation among Post Tuberculosis Patients in Vietnam: An Observational Study. Journal of fungi (Basel, Switzerland), 7(7), 532. https://doi.org/10.3390/jof7070532
Rønberg, R., Davidsen, J. R., Salzer, H. J. F., Van Braeckel, E., Rosenvinge, F. S., & Laursen, C. B. (2022).
Prevalence of Chronic Pulmonary Aspergillosis in Patients Suspected of Chest Malignancy. Journal of fungi (Basel, Switzerland), 8(3), 297. https://doi.org/10.3390/jof8030297
Wu, J., Zhang, T., Pan, J., Zhang, Q., Lin, X., Chang, L., Chen, Y. C., & Xue, X. (2021). Characteristics of the
Computed Tomography Imaging Findings in 72 Patients with Airway-Invasive Pulmonary Aspergillosis. Medical science monitor : international medical journal of experimental and clinical research, 27, e931162. https://doi.org/10.12659/MSM.931162
