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Kim J, Lee KH, Cho JY, Kim J, Shin YJ, Lee KW. Usefulness of CT-Guided Percutaneous Transthoracic Needle Lung Biopsies in Patients with Suspected Pulmonary Infection. Korean J Radiol 2020; 21:526-536. [PMID: 32323498 PMCID: PMC7183825 DOI: 10.3348/kjr.2019.0492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 01/05/2020] [Indexed: 01/05/2023] Open
Abstract
Objective This study aimed to evaluate the clinical benefits and risks of CT-guided percutaneous transthoracic needle lung biopsies (PTNBs) in patients with a suspected pulmonary infection. Materials and Methods This study included 351 CT-guided PTNBs performed in 342 patients (mean age, 58.9 years [range, 17–91 years]) with suspected pulmonary infection from January 2010 to December 2016. The proportion of biopsies that revealed the causative organism for pulmonary infection and that influenced patient's treatment were measured. Multivariate analyses were performed to identify factors associated with PTNB that revealed the causative organism or affected the treatment. Finally, the complication rate was measured. Results CT-guided PTNB revealed the causative organism in 32.5% of biopsies (114/351). The presence of necrotic components in the lesion (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1–2.7; p = 0.028), suspected pulmonary tuberculosis (OR, 2.0; 95% CI, 1.2–3.5; p = 0.010), and fine needle aspiration (OR, 2.5; 95% CI, 1.1–5.8; p = 0.037) were factors associated with biopsies that revealed the causative organism. PTNB influenced patient's treatment in 40.7% (143/351) of biopsies. The absence of leukocytosis (OR, 1.9; 95% CI, 1.0–3.7; p = 0.049), presence of a necrotic component in the lesion (OR, 2.4; 95% CI, 1.5–3.8; p < 0.001), and suspected tuberculosis (OR, 1.7; 95% CI, 1.0–2.8; p = 0.040) were factors associated with biopsies that influenced the treatment. The overall complication rate of PTNB was 19% (65/351). Conclusion In patients with suspected pulmonary infection, approximately 30–40% of CT-guided PTNBs revealed the causative organism or affected the treatment. The complication rate of PTNB for suspected pulmonary infection was relatively low.
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Affiliation(s)
- Junghoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyung Hee Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
| | - Jun Yeun Cho
- Department of Internal Medicine, Chungbuk National University Hospital, Division of Pulmonary and Critical Care Medicine, Cheongju, Korea
| | - Jihang Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoon Joo Shin
- Department of Radiology, Konkuk University Medical Center, Seoul, Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Cleveland H, Chau A, Jeng Z, Gardner G, Yoo R, Zhang W, Hernandez J. Percutaneous Lung Biopsy in Immunocompromised Pediatric Patients. J Vasc Interv Radiol 2019; 31:93-98. [PMID: 31767410 DOI: 10.1016/j.jvir.2019.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To determine the diagnostic yield and safety of image-guided lung biopsies in immunocompromised pediatric patients. MATERIALS AND METHODS This was a retrospective pediatric cohort study conducted from June 2000 to April 2017. Subjects were 0-17 years of age (median, 10 years of age). There were 46 males (48%). A total of 73 consecutive image-guided lung biopsies were performed in 68 patients (weight range, 4.9-97.3 kg [median, 25.3 kg]). The indication for biopsy was to isolate an organism to tailor medical therapy. All patients were immunocompromised with an underlying history of bone marrow transplantation (n = 50), primary immunodeficiency (n = 14), and solid organ transplantation (n = 4). Patient and technical factors were analyzed for rates of complication. RESULTS Overall diagnostic yield was 43 of 73 patients (60%). There were 14 minor (19%) and 8 major (11%) complications. Major complications included pneumothorax or hemoptysis requiring intervention (n = 6), and death (n = 2). The histological diagnosis was an infectious cause in 5 of 8 major complications (63%). There were statistically significant differences between the rates of complications with the imaging modality used (P = .02) and the use of fine needle aspiration (P = .02). CONCLUSIONS Image-guided percutaneous lung biopsy can be helpful in isolating an organism to tailor therapy. Biopsies performed in immunosuppressed patients result in an elevated complication risk of up to 30% and demonstrate lower diagnostic yield and increased mortality, which should warrant detailed discussion with the primary team and family.
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Affiliation(s)
- Heather Cleveland
- Department of Interventional Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030-2608
| | - Alex Chau
- Department of Interventional Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030-2608; Department of Interventional Radiology, Baylor College of Medicine, Houston, Texas
| | - Zachary Jeng
- Department of Interventional Radiology, Baylor College of Medicine, Houston, Texas
| | - Gregory Gardner
- Department of Interventional Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030-2608; Department of Interventional Radiology, Baylor College of Medicine, Houston, Texas
| | - Raphael Yoo
- Department of Interventional Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030-2608; Department of Interventional Radiology, Baylor College of Medicine, Houston, Texas
| | - Wei Zhang
- Department of Interventional Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030-2608
| | - Jose Hernandez
- Department of Interventional Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030-2608; Department of Interventional Radiology, Baylor College of Medicine, Houston, Texas.
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Grabala J, Grabala M, Onichimowski D, Grabala P. Possibilities of using ultrasound for diagnosis of invasive pulmonary mucormycosis – A case study. POLISH ANNALS OF MEDICINE 2017. [PMCID: PMC7172815 DOI: 10.1016/j.poamed.2016.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction Mucormycosis is a rare but highly lethal fungal infection, usually affecting immunocompromised patients. Aim To present and analyze the diagnostic capabilities of transthoracic ultrasonography in invasive pulmonary mucormycosis. Case study We present a case involving a 41-year-old female patient with pneumonia complicated by multisystem organ failure, who was diagnosed with invasive pulmonary mucormycosis. Results and discussion Transthoracic ultrasonography (TUS) revealed a consolidation area of heterogeneous echostructure with an abnormal air bronchogram, possibly suggestive of an invasive pulmonary fungal disorder. The presence of lesions observed with TUS was confirmed by computed tomography (CT). The final diagnosis of mucormycosis was possible after Mucor species fungi were detected in bronchoalveolar lavage culture. Conclusions (1) TUS is a widely available and inexpensive diagnostic method that is characterized by the absence of adverse effects, and its applicability in the diagnosis of pulmonary disorders other than invasive fungal infections is well documented. (2) Ultrasonographic analysis of lesions facilitates differentiation between bacterial and fungal pneumonia, and the high sensitivity and specificity of the procedure compared to CT scans as a reference method supports the reliability of ultrasound scans in the diagnosis of invasive pulmonary aspergillosis (IPA). (3) The use of TUS in the diagnosis of invasive pulmonary mucormycosis appears warranted, particularly in cases when it is impossible to obtain a proven diagnosis. (4) Ultrasonographic diagnosis of invasive lung disorders, including mucormycosis, requires further studies.
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Anzidei M, Porfiri A, Andrani F, Di Martino M, Saba L, Catalano C, Bezzi M. Imaging-guided chest biopsies: techniques and clinical results. Insights Imaging 2017. [PMID: 28639114 PMCID: PMC5519500 DOI: 10.1007/s13244-017-0561-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background This article aims to comprehensively describe indications, contraindications, technical aspects, diagnostic accuracy and complications of percutaneous lung biopsy. Methods Imaging-guided biopsy currently represents one of the predominant methods for obtaining tissue specimens in patients with lung nodules; in many cases treatment protocols are based on histological information; thus, biopsy is frequently performed, when technically feasible, or in case other techniques (such as bronchoscopy with lavage) are inconclusive. Results Although a coaxial system is suitable in any case, two categories of needles can be used: fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB), with the latter demonstrated to have a slightly higher overall sensitivity, specificity and accuracy. Conclusion Percutaneous lung biopsy is a safe procedure even though a few complications are possible: pneumothorax, pulmonary haemorrhage and haemoptysis are common complications, while air embolism and seeding are rare, but potentially fatal complications. Teaching points • Imaging-guided biopsy is one of the main methods to obtain lung nodule specimens. • CT has the highest accuracy for diagnosis as an imaging guide. • Compared to FNAB, CNB has a higher accuracy for diagnosis. • Pneumothorax and parenchymal pulmonary haemorrhage care the most frequent complications. • Several clinical and technical variables can affect diagnostic accuracy and patient safety.
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Affiliation(s)
- Michele Anzidei
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy.
| | - Andrea Porfiri
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Fabrizio Andrani
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Michele Di Martino
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari, Polo di Monserrato, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Mario Bezzi
- Department of Radiological, Oncological and Anatomopathological Sciences, Radiology, Sapienza, University of Rome, Policlinico Umberto I, Viale Regina Elena, 324, 00161, Rome, Italy
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Maschmeyer G, Carratalà J, Buchheidt D, Hamprecht A, Heussel CP, Kahl C, Lorenz J, Neumann S, Rieger C, Ruhnke M, Salwender H, Schmidt-Hieber M, Azoulay E. Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients (allogeneic SCT excluded): updated guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Oncol 2015; 26:21-33. [PMID: 24833776 PMCID: PMC4269340 DOI: 10.1093/annonc/mdu192] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 04/29/2014] [Accepted: 05/02/2014] [Indexed: 12/13/2022] Open
Abstract
Up to 25% of patients with profound neutropenia lasting for >10 days develop lung infiltrates, which frequently do not respond to broad-spectrum antibacterial therapy. While a causative pathogen remains undetected in the majority of cases, Aspergillus spp., Pneumocystis jirovecii, multi-resistant Gram-negative pathogens, mycobacteria or respiratory viruses may be involved. In at-risk patients who have received trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis, filamentous fungal pathogens appear to be predominant, yet commonly not proven at the time of treatment initiation. Pathogens isolated from blood cultures, bronchoalveolar lavage (BAL) or respiratory secretions are not always relevant for the etiology of pulmonary infiltrates and should therefore be interpreted critically. Laboratory tests for detecting Aspergillus galactomannan, β-D-glucan or DNA from blood, BAL or tissue samples may facilitate the diagnosis; however, most polymerase chain reaction assays are not yet standardized and validated. Apart from infectious agents, pulmonary side-effects from cytotoxic drugs, radiotherapy or pulmonary involvement by the underlying malignancy should be included into differential diagnosis and eventually be clarified by invasive diagnostic procedures. Pre-emptive treatment with mold-active systemic antifungal agents improves clinical outcome, while other microorganisms are preferably treated only when microbiologically documented. High-dose TMP/SMX is first choice for treatment of Pneumocystis pneumonia, while cytomegalovirus pneumonia is treated primarily with ganciclovir or foscarnet in most patients. In a considerable number of patients, clinical outcome may be favorable despite respiratory failure, so that intensive care should be unrestrictedly provided in patients whose prognosis is not desperate due to other reasons.
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Affiliation(s)
- G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany.
| | - J Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - D Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, Mannheim
| | - A Hamprecht
- Institution for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne
| | - C P Heussel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital, Heidelberg
| | - C Kahl
- Department of Hematology and Oncology, Klinikum Magdeburg, Magdeburg
| | - J Lorenz
- Department of Pneumology, Infectious Diseases, Sleep Medicine and Intensive Care, Klinikum Lüdenscheid, Lüdenscheid
| | - S Neumann
- Medical Oncology, AMO MVZ, Wolfsburg
| | - C Rieger
- Department of Medicine III, University Hospital Großhadern, München
| | - M Ruhnke
- Department of Medical Oncology and Hematology, Charité University Medicine Campus Mitte, Berlin
| | - H Salwender
- Department of Hematology, Oncology, Stem Cell Transplantation, Asklepios Klinik Altona, Hamburg
| | - M Schmidt-Hieber
- Department of Hematology, Oncology and Tumor Immunology, Helios-Klinikum Berlin-Buch, Berlin, Germany
| | - E Azoulay
- AP-HP, Hopital Saint-Louis, Service de Réanimation Médicale, Université Paris-Diderot, Sorbonne Paris-Cité, Faculté de Médecine, Paris, France
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Kropshofer G, Kneer A, Edlinger M, Meister B, Salvador C, Lass-Flörl C, Freund M, Crazzolara R. Computed tomography guided percutaneous lung biopsies and suspected fungal infections in pediatric cancer patients. Pediatr Blood Cancer 2014; 61:1620-4. [PMID: 24803392 DOI: 10.1002/pbc.25091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 04/14/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND The spectrum of potential fungal pathogens known to cause invasive pulmonary infections has grown as a result of intensified immunosuppressive therapy and the emergence of antifungal resistance. PROCEDURE In a retrospective single center study, we investigated computed tomography guided percutaneous lung biopsies in 16 childhood patients with suspected fungal infections. Microbiological analysis consisted of microscopic examination, culture, and a broad-range fungal polymerase chain reaction for detection of either Aspergillus or Mucorales species. RESULTS In 14 patients (88%), invasive fungal infection with Aspergillus species including A. terreus, Mucormycetes, and Saccharomyces cerevisiae being the main pathogens was confirmed, including patients with a double infection (19%). In two cases, the most likely diagnosis of primary bronchiolitis obliterans organizing pneumonia was established based on the results of typical histopathologic features, negative culture results, and symptoms resolved after treatment with high-dose cortisone. Diagnosis of invasive fungal pneumonia led to an immediate interruption of antineoplastic treatment in 100%, reduction of antibiotic drugs in 76%, and change of empirical to targeted antifungal therapy in 63%. The safety of lung biopsy was guaranteed by lack of any complications, such as bleeding or pneumothorax. CONCLUSIONS The increased detection of rare fungal infections by computed tomography guided biopsy supports the need for a rapid and precise diagnosis, as most of the fungal pathogens are at least partially resistant to available antifungal therapy and proper treatment is essential for best practice in patient management.
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Naumann H, Pittaway A, Lynn AM, Vo NJ. CT-guided percutaneous lung biopsy under general anesthesia: a pediatric case series and literature review. Paediatr Anaesth 2012; 22:469-75. [PMID: 22211910 DOI: 10.1111/j.1460-9592.2011.03773.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe 14 consecutive children who received computed tomography-guided percutaneous lung biopsy (CT-PLB) under general anesthesia over an 18-month period at our institution. Pulmonary hemorrhage (occurring in 36%) and pneumothorax (29%) were the two most common complications; the overall complication rate was 64%. When complications did occur, immediate airway management was facilitated by the presence of an endotracheal tube (ETT). We conclude as follows: (i) CT-PLB in our series is associated with a high risk of both overall and severe complications; (ii) risk of complications is increased by both patient and procedure-related factors; (iii) airway management with ETT may be preferable should a complication arise; (iv) severe complications may necessitate ICU admission, which should be available before proceeding.
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Affiliation(s)
- Heather Naumann
- Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital, Seattle, WA 98105, USA
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8
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Garcia X, Mian A, Mendiratta P, Gupta P, Rycus P, Prodhan P. Aspergillus infection and extracorporeal membrane oxygenation support. J Intensive Care Med 2012; 28:178-84. [PMID: 22328597 DOI: 10.1177/0885066611432542] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The clinical characteristics of patients with Aspergillus isolation while supported on extracorporeal membrane oxygenator (ECMO) remain unclear. OBJECTIVES We present a case report of angioinvasive Aspergillus infection on an infant supported on ECMO and also investigate outcomes among patients with Aspergillus infection reported to the Extracorporeal Life Support Organization (ELSO) registry. DESIGN Case report and retrospective analysis of ELSO registry data set from 1985 to 2009. SETTING One hundred and seventy ECMO centers contributing data to the ELSO registry. PATIENTS Single case report and patients 0 to 90 years of age with Aspergillus infection requiring ECMO support as reported to the ELSO registry. METHODS Besides presenting details of our institutional case, we compared clinical characteristics and outcomes between pediatric and adult patients with Aspergillus isolation. Risk factors for in-hospital mortality were investigated. Kaplan-Meier estimates for freedom from death on ECMO for pediatric and adult patients were investigated. MEASUREMENTS AND MAIN RESULTS (a) we report a case with Aspergillus supported on ECMO, (b) the ELSO registry yielded 46 patients with 59% (n = 27) in the pediatric data set (≤20 years of age) and 41% (n = 19) in the adult data set (>20 years of age) with Aspergillus infection requiring ECMO support. Overall survival to hospital discharge was 30% (14/46) with 22% (6/27) in children as compared to 42% (8/18) in adults (P = .19). Table 1 shows a comparison of clinical characteristics between children and adults. The comparison between adults and pediatric groups differed significantly in age (P = .0001), more use of venoarterial ECMO in children (P = .028). The median age of pediatric group was 1.95 years (range 0-17.3 years) versus 30.2 years (range 22-60 years) among adults. CONCLUSIONS Aspergillus infection/colonization is associated with a 70% overall mortality among patients supported on ECMO. The ELSO registry data confirms that Aspergillus infection among ECMO supported patients occurs often in hosts who do not have known immunodeficiencies. The case stresses the need for a high level of suspicion for Aspergillus infection in nonimproving lung disease in patients on ECMO support.
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Affiliation(s)
- Xiomara Garcia
- Department of Pediatrics, Division of Pediatric Critical Care, College of Medicine, University of Arkansas Medical Sciences, Arkansas Children Hospital, Little Rock, AR, USA.
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Abstract
The incidence of invasive fungal infections (IFI) has increased substantially and the epidemiology has changed dramatically in recent years. Candida albicans is still most important, but non-albicans species, Aspergillus species, Glomeromycota (formerly Zygomycetes) and Fusarium species are an increasing cause of IFIs. Due to this growing diversity, the identification of the causative organism to genus and species level is important to perform best and adequate treatment. The early, sensitive and specific detection of IFIs remains challenging and current conventional methods are limited. The golden standard for the definite diagnosis of proven pulmonary infection remains either histopathologic, cytopathologic or direct tissue examination. Invasive procedures are necessary to obtain reliable specimens and biopsies may be taken percutaneously, bronchoscopically, via open surgery or via video-assisted thorascopic surgery. Molecular methods, like PCR or in situ hybridization, are a promising diagnostic tool for rapid and reliable species identification and should be performed in addition to microscopic examination and culture to increase the sensitivity for the diagnosis of IFI. Combining culture, microscopy, serology, and PCR in lung tissues and/or bronchial samples will increase the diagnostic yield by 99%. Here, we give an overview of biopsy procedures for molecular tissue diagnosis of IFI.
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Hogan MJ. Infection in pediatric interventional radiology. Pediatr Radiol 2011; 41 Suppl 1:S99-106. [PMID: 21523578 DOI: 10.1007/s00247-011-2000-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 01/12/2011] [Accepted: 01/18/2011] [Indexed: 10/18/2022]
Abstract
Interventional radiology in children involves nearly every aspect of infectious disease. Diagnosis, treatment, prophylaxis and disease transmission in infectious disease are a daily part of pediatric interventional radiology practice. This article will discuss each of these aspects of infection with respect to interventional radiology.
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Affiliation(s)
- Mark J Hogan
- Department of Radiology, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA.
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Roebuck DJ, Hogan MJ, Connolly B, McLaren CA. Interventions in the Chest in Children. Tech Vasc Interv Radiol 2011; 14:8-15. [DOI: 10.1053/j.tvir.2010.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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12
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Park SJ. A Case of Successful Treatment of Cutaneous Aspergillosis with Voriconazole at the Low Cyclosporine Trough Level in a Renal Transplant. ACTA ACUST UNITED AC 2010. [DOI: 10.4285/jkstn.2010.24.1.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Seok-Ju Park
- Organ Transplantation Center, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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13
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Maschmeyer G, Beinert T, Buchheidt D, Cornely OA, Einsele H, Heinz W, Heussel CP, Kahl C, Kiehl M, Lorenz J, Hof H, Mattiuzzi G. Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients: Guidelines of the infectious diseases working party of the German Society of Haematology and Oncology. Eur J Cancer 2009; 45:2462-72. [DOI: 10.1016/j.ejca.2009.05.001] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Revised: 04/27/2009] [Accepted: 05/01/2009] [Indexed: 12/15/2022]
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14
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Steinfort DP, Wurzel D, Irving LB, Ranganathan SC. Endobronchial ultrasound in pediatric pulmonology. Pediatr Pulmonol 2009; 44:303-8. [PMID: 19283761 DOI: 10.1002/ppul.20991] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endobronchial ultrasound (EBUS) is a recently introduced technique that has significantly advanced bronchoscopic techniques in adult medicine. Use of ultrasound allows far more accurate localization and sampling of both peripheral pulmonary, as well as mediastinal and hilar lesions. This has led to greater diagnostic success, with a reduced rate of complications. Its performance characteristics in adult populations are equivalent to surgical procedures previously considered gold standard, but it has dramatically reduced morbidity and mortality among patients requiring invasive diagnostic procedures, when compared to surgical approaches. We describe the types of EBUS in clinical use, the method of use, the clinical indications for each procedure, and the potential role for EBUS in pediatric pulmonology. Radial probe EBUS is used in the investigation of peripheral lung lesions and could be adopted in children to achieve accurate biopsy of such lesions. Linear probe EBUS allows minimally invasive biopsy of mediastinal and hilar lesions. It has potentially greater performance characteristics than current biopsy techniques, with no significant complications reported to date. It may be useful in the diagnosis of lymphoma, or neurogenic tumors, as well as many other diseases resulting in mediastinal or hilar lymphadenopathy. EBUS is a minimally invasive technique that allows tissue sampling of peripheral lung lesions, or mediastinal/hilar masses, with a high diagnostic accuracy, and a significantly lower morbidity and mortality than alternative approaches. The indications for and the use of EBUS in pediatric patients is certain to increase in the future.
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Affiliation(s)
- Daniel P Steinfort
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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15
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Pulmonary Aspergillosis in Solid Organ Transplant Patients: A Report From Iran. Transplant Proc 2008; 40:3663-7. [DOI: 10.1016/j.transproceed.2008.06.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 06/27/2008] [Indexed: 11/21/2022]
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16
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Doganis D, Baka M, Pourtsidis A, Bouhoutsou D, Varvoutsi M, Stamos G, Anastasiou N, Androulakakis E, Vasilatou-Kosmidis H. Successful combination of antifungal agents and surgical resection for pulmonary aspergillosis in a child with Hodgkin disease: review of the literature. Pediatr Hematol Oncol 2007; 24:631-8. [PMID: 18092254 DOI: 10.1080/08880010701620988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The authors report on a 14-year-old adolescent boy suffering of Hodgkin disease in remission, who developed autoimmune anemia and thrombopenia. He was treated with high-dose steroids and he developed serious invasive lung aspergillosis, which was treated with antifungal agents and surgical intervention. Children suffering from cancer are prone to develop systemic fungal infections secondary to the severe immunosuppression caused by the disease itself and the antineoplastic therapy. Intravenous antifungal medications and, when feasible, surgery are used for treatment of pulmonary aspergillosis. Factors related to better outcome are early diagnosis, remission of underlying disease, aggressive antifungal therapy, and recovery from neutropenia.
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Affiliation(s)
- Dimitrios Doganis
- Oncology Department, Children's Hospital Aglaia Kyriakou, Athens, Greece.
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Theron S, Andronikou S, Du Plessis J, Goussard P, George R, Mapukata A, Grobbelaar M, Hayes M, Wieselthaler N, Davidson A. Pulmonary Kaposi sarcoma in six children. Pediatr Radiol 2007; 37:1224-9. [PMID: 17940761 DOI: 10.1007/s00247-007-0632-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 07/12/2007] [Accepted: 08/19/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pulmonary involvement in Kaposi sarcoma is rare in children and can be difficult to distinguish from other pathology. OBJECTIVE To describe the radiological findings in paediatric pulmonary Kaposi sarcoma. MATERIALS AND METHODS Sequential chest radiographs of six children and CT scans of four of these children were evaluated retrospectively. Their ages ranged from 18 months to 10 years; four were male and two were female. All six children were HIV-positive. The observers were two radiologists. RESULTS Chest radiographs revealed air-space (100%) and reticular (83%) opacification in the mid- and lower lung zones; pleural effusions were present in 83% of the children. All the children showed progressive air-space opacification on follow-up radiography. CT demonstrated bilateral air-space opacification in a perihilar distribution in all the children; reticular opacification was seen in 75%. All the children had mediastinal and axillary lymphadenopathy; 75% had bilateral hilar lymphadenopathy. CONCLUSION In both adults and children, chest radiography demonstrates perihilar and lower zone involvement. Pleural effusions are more common on radiographs in children. Air-space disease and lymphadenopathy are much more common on CT in children than adults.
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Affiliation(s)
- Salomine Theron
- Department of Radiology, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa.
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Armenian SH, Hoffman JA, Butturini AM, Kapoor N, Mascarenhas L. Invasive diagnostic procedures for pulmonary infiltrates in pediatric hematopoietic stem cell transplant recipients. Pediatr Transplant 2007; 11:736-42. [PMID: 17910650 DOI: 10.1111/j.1399-3046.2007.00733.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To evaluate the role of BAL, CTB, and OLB in the management of pulmonary infiltrates in pediatric HSCT recipients, we conducted a retrospective review of clinical records of pediatric HSCT recipients. Data were analyzed using Chi-square for dichotomous and anova for continuous variables. Logistic regression was used to adjust confounding variables for diagnostic yield. Forty patients underwent 44 separate procedures. Infections were the prevailing cause of infiltrates with a positive diagnostic yield (96%). CTB and OLB were performed more often in patients with focal infiltrates compared with BAL (100%, 71% vs. 22%; p < 0.01). Adverse events were not significantly different across the three procedures. OLB more often yielded information that led to change in medical management (71% vs. 0%, 34%; p < 0.05) compared with CTB and BAL. Patients who had a positive diagnostic yield had no apparent survival advantage when compared with those in whom a procedure yielded no information. Logistic regression demonstrated that focal infiltrate was the only independently predictive variable for identifying a cause of pulmonary infiltrate. In conclusion, all three invasive diagnostic procedures were safe. Having a focal infiltrate was independently and significantly associated with having a positive diagnostic yield.
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Affiliation(s)
- Saro H Armenian
- Division of Hematology/Oncology, Childrens Hospital Los Angeles, Los Angeles, CA, USA
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19
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Abstract
Interventional radiology has become increasingly involved in the diagnosis and management of the pediatric oncology patient. Percutaneous biopsy and needle aspiration can be performed for solid and liquid lesions with image guidance, both for the primary diagnosis and for management of sequelae of cancer therapy. Therapeutic options also can be performed with image guidance, including radiofrequency ablation and transarterial chemoembolization. When surgical resection is required, image guided tumor localization can be used to aid in identifying small lesions.
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Affiliation(s)
- Mark A Bittles
- Department of Radiology, Division of Interventional Radiology, Children's Hospital and Regional Medical Center and University of Washington, Seattle, USA
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20
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Collaco JM, Gower WA, Mogayzel PJ. Pulmonary dysfunction in pediatric hematopoietic stem cell transplant patients: overview, diagnostic considerations, and infectious complications. Pediatr Blood Cancer 2007; 49:117-26. [PMID: 17029246 DOI: 10.1002/pbc.21061] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Pulmonary complications are among the most common and serious sequelae seen in hematopoietic stem cell transplantation (HSCT) recipients. This two-part review addresses the incidence and impact of pulmonary complications in pediatric HSCT patients. In this first part we review the available data for the use of diagnostic modalities in this population, including flexible bronchoscopy with bronchoalveolar lavage (BAL) and open lung biopsy (OLB). We also review the many infectious pulmonary complications that may occur in pediatric HSCT recipients, utilizing the traditional chronologic divisions of neutropenic phase (0-30 days following HSCT), early phase (30-100 days), and late phase (>100 days).
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MESH Headings
- Anti-Infective Agents/therapeutic use
- Antineoplastic Agents/adverse effects
- Biopsy
- Bronchoalveolar Lavage Fluid
- Bronchoscopy
- Child
- Child, Preschool
- Hematopoietic Stem Cell Transplantation
- Humans
- Immunocompromised Host
- Incidence
- Infant
- Lung Diseases/diagnosis
- Lung Diseases/etiology
- Lung Diseases, Fungal/diagnosis
- Lung Diseases, Fungal/drug therapy
- Lung Diseases, Fungal/epidemiology
- Lung Diseases, Fungal/etiology
- Lung Diseases, Fungal/microbiology
- Neoplasms/complications
- Neoplasms/surgery
- Neutropenia/etiology
- Pneumonia/diagnosis
- Pneumonia/drug therapy
- Pneumonia/epidemiology
- Pneumonia/etiology
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/drug therapy
- Pneumonia, Bacterial/epidemiology
- Pneumonia, Bacterial/etiology
- Pneumonia, Bacterial/microbiology
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/drug therapy
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/etiology
- Pneumonia, Viral/virology
- Postoperative Complications/diagnosis
- Postoperative Complications/drug therapy
- Postoperative Complications/epidemiology
- Postoperative Complications/etiology
- Postoperative Period
- Time Factors
- Tomography, X-Ray Computed
- Transplantation Conditioning/adverse effects
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Affiliation(s)
- J Michael Collaco
- Eudowood Division of Pediatric Respiratory Sciences, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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21
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Nosari A, Ravini M, Cairoli R, Cozzi P, Marbello L, Marenco P, Grillo G, Morra E. Surgical resection of persistent pulmonary fungus nodules and secondary prophylaxis are effective in preventing fungal relapse in patients receiving chemotherapy or bone marrow transplantation for leukemia. Bone Marrow Transplant 2007; 39:631-5. [PMID: 17384656 DOI: 10.1038/sj.bmt.1705655] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antifungal therapy may be unable to eradicate invasive mycosis in leukemia patients. The presence of persisting pulmonary nodules owing to mycosis seems to increase the risk of fungal relapse after chemotherapy and transplant procedures. Between 1997 and 2004, 10 acute leukemia patients underwent pulmonary surgery for invasive mycosis. The median time from diagnosis of mycosis to surgery was 135 days (range 21-147). Three patients underwent emergency surgery, owing to hemoptysis. In the other seven patients with nodule/cavitation remaining after antifungal treatment, surgery (three wedge resections, four lobectomies) was scheduled before transplant. Pathologic examination confirmed two aspergillosis and three zygomycosis. The only side effect was pneumothorax in one case. Nine patients were considered cured. Six patients underwent bone marrow transplantation (three allogeneic, three autologous) with antifungal prophylaxis without relapse during the transplant procedure. In selected patients scheduled for bone marrow transplantation, surgical resection of localized pulmonary fungus nodules combined with antifungal prophylaxis seem to be an effective treatment for preventing mycotic relapse.
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MESH Headings
- Adult
- Aged
- Antifungal Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Aspergillosis/drug therapy
- Aspergillosis/etiology
- Aspergillosis/prevention & control
- Aspergillosis/surgery
- Bone Marrow Transplantation/adverse effects
- Female
- Humans
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/therapy
- Lung Diseases, Fungal/drug therapy
- Lung Diseases, Fungal/etiology
- Lung Diseases, Fungal/prevention & control
- Lung Diseases, Fungal/surgery
- Male
- Middle Aged
- Mucormycosis/drug therapy
- Mucormycosis/etiology
- Mucormycosis/prevention & control
- Mucormycosis/surgery
- Recurrence
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Affiliation(s)
- A Nosari
- Department of Hematology, Niguarda Ca'Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
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22
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Armenian SH, La Via WV, Siegel SE, Mascarenhas L. Evaluation of persistent pulmonary infiltrates in pediatric oncology patients. Pediatr Blood Cancer 2007; 48:165-72. [PMID: 16411212 DOI: 10.1002/pbc.20747] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate the role of bronchoalveolar lavage (BAL), computed-tomography-guided biopsy (CTB), and open lung biopsy (OLB) in the management of persistent pulmonary infiltrates in pediatric oncology patients. METHODS Retrospective review of clinical records of pediatric oncology patients who underwent BAL, CTB, and OLB over a 7-year period. Data was compared across the three procedures using chi-square analysis. Logistic regression was used to adjust potential confounding variables for diagnostic yield. RESULTS There were 113 consecutive patients who underwent 140 separate procedures during their hospitalization. Thirty (26%) patients had a previous BMT. BALs were more likely to occur as the first line of investigation (98% vs. 47%, 45%; P < 0.01) and in patients with diffuse infiltrates (64% vs. 6%, 26%; P < 0.01) when compared to CTB and OLB, respectively. OLBs were performed less frequently in neutropenic patients (26% vs. 53%, 54%; P < 0.05), more often led to change in management directly because of procedure (61% vs. 12%, 33%; P < 0.01), and had higher diagnostic yield (61% vs. 24%, 36%; P < 0.01) when compared to CTB and BAL, respectively. Diagnostic yield of OLB was significantly higher regardless of diffuse or focal nature of infiltrate. Major adverse events after a procedure were not significantly different across the three procedures. Logistic regression demonstrated that having an OLB was independently associated with identifying the cause of pulmonary infiltrate. CONCLUSION OLB appears to be safe, has the best diagnostic yield, and leads to change in management more often than CTB or BAL in pediatric oncology patients with persistent pulmonary infiltrates.
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Affiliation(s)
- Saro H Armenian
- Division of Hematology/Oncology, Childrens Hospital Los Angeles, Los Angeles, California 90027, USA
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23
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Pagano L, Fianchi L, Leone G. Fungal pneumonia due to molds in patients with hematological malignancies. J Chemother 2006; 18:339-52. [PMID: 17024788 DOI: 10.1179/joc.2006.18.4.339] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Invasive fungal infections are an important cause of morbidity and mortality in patients with hematological malignancies. In particular, patients with neutropenia and those who have undergone allogeneic hematopoietic stem cell transplantation are at highest risk, with fungal pneumonia being the main clinical manifestation in these patients. The most common pathogens associated with fungal pneumonia are Aspergillus spp. and Zygomycetes. However, other pathogens have also been observed in fungal pneumonia, including Cryptococcus spp., Pneumocystis jirovecii, and Candida spp. This comprehensive review will focus on the important practical aspects relevant to the epidemiology, clinical diagnosis, and therapeutic management of pneumonia due to filamentous fungi in patients affected by hematological malignancies.
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Affiliation(s)
- L Pagano
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy.
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24
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Abstract
The respiratory tract is the most common system affected by aspergillosis in children with hematologic malignancies. However, Aspergillus spp. tend to invade blood vessels, resulting in systemic dissemination to multiple organs including, but not limited to, the brain, bones, liver, kidneys, and skin. Because early diagnosis and treatment are critical to the patient's outcome, a high index of suspicion should be maintained in children with hematologic malignancies who are neutropenic and have prolonged fever that is unresponsive to systemic antibacterials. Several diagnostic modalities should be used simultaneously in order to establish the diagnosis in an expeditious manner. Detailed radiographic evaluations with plain radiographs, and CT scans of the chest, sinuses, brain, and other organs should be performed as soon as clinical suspicion is raised. Detection of circulating antigens, such as galactomannan and 1,3-beta-glucan, and polymerase chain reaction appear promising in aiding in the diagnosis. A definitive diagnosis requires both a positive culture from a sterile site and evidence of tissue damage demonstrated by imaging studies or microscopic evaluations of sites of infection. Because the mortality rate is very high, empiric systemic antifungal therapy with amphotericin B, or one of its lipid formulations, should be initiated while laboratory investigations to substantiate or refute the diagnosis are continued. Surgical intervention is associated with a high mortality rate but may be of benefit in children with localized disease.
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Affiliation(s)
- Rashed A Hasan
- Michigan State University, Hurley Medical Center, Flint, Michigan 48503, USA
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25
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Brodoefel H, Vogel M, Hebart H, Einsele H, Vonthein R, Claussen C, Horger M. Long-term CT follow-up in 40 non-HIV immunocompromised patients with invasive pulmonary aspergillosis: kinetics of CT morphology and correlation with clinical findings and outcome. AJR Am J Roentgenol 2006; 187:404-13. [PMID: 16861545 DOI: 10.2214/ajr.05.0513] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to assess CT signs of invasive pulmonary aspergillosis (IPA) and their long-term kinetics in correlation with clinical findings and outcome. MATERIALS AND METHODS Three hundred ten serial CT scans (mean, 7.7) in 40 consecutive patients were reviewed retrospectively over a median follow-up of 112 days (range, 5-841 days). Along with underlying disease, hematopoietic stem cell transplantation, neutropenia, graft-versus-host disease or antifungal treatment, signs of IPA, and number or size of lesions were evaluated regarding outcome and radiologic dynamics. RESULTS On the day of IPA diagnosis, median lesion number and size were 3 or 3.1 cm(2), respectively. Irrespective of antifungal therapy, 90% of patients showed an increase in lesion size and number until day 9 (median and mean). Lesion size subsequently showed a median plateau phase of 3.5 days (mean, 7), during which median lesion numbers dropped by 17%. Consequently, 42.5% of patients showed a complete radiologic remission within a median 80 days. Of all parameters, formation of cavitation most strongly predicted time until radiologic remission, which was 2.5 times as long in patients with cavitary lesions. Likewise, cavitations were strong precursors of beneficial outcome (odds ratio, 8.4; confidence interval [CI], 1.07-176). CONCLUSION The kinetics of radiologic signs of IPA adheres to a distinctive pattern with initial rise in number and size, followed by a plateau phase of size and gradual reduction. Both time until complete radiologic remission and outcome are independent of initial or maximum lesion size and number yet strongly influenced by cavitation.
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Affiliation(s)
- Harald Brodoefel
- Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany.
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26
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Hoffer FA. Interventional radiology in pediatric oncology. Eur J Radiol 2005; 53:3-13. [PMID: 15607848 DOI: 10.1016/j.ejrad.2004.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Revised: 07/20/2004] [Accepted: 07/26/2004] [Indexed: 02/01/2023]
Abstract
There are many radiological interventions necessary for pediatric oncology patients, some of which may be covered in other articles in this publication. I will discuss a number of interventions including percutaneous biopsy for solid tumor and hematological malignancy diagnosis or recurrence, for the diagnosis of graft versus host disease after stem cell or bone marrow transplantation, and for the diagnosis of complications of immunosuppression such as invasive pulmonary aspergillosis. In the past, tumor localization techniques have been necessary to biopsy or resect small lesions. However improved guidance techniques have allowed for more precise biopsy and the use of thermal ablation instead of excision for local tumor control. A percutaneously placed radio frequency, microwave, laser or cryogen probe can ablate the primary and metastatic tumors of the liver, lung, bone, kidney and other structures in children. This is an alternative treatment for the local control of tumors that may not be amenable to surgery, chemotherapy or radiotherapy. I will also describe how chemoembolization can be used to treat primary or metastatic tumors of the liver that have failed other therapies. This treatment delivers chemotherapy in the hepatic artery infused with emboli to increase the dwell time and concentration of the agents.
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Affiliation(s)
- Fredric A Hoffer
- Division of Diagnostic Imaging, Department of Radiological Sciences, St. Jude Children's Research Hospital, 332 N. Lauderdale St., Memphis, TN 38105, USA.
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27
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Abuhammour W, Hasan RA. Treatment of invasive Aspergillosis in children with hematologic malignancies. Indian J Pediatr 2004; 71:837-43. [PMID: 15448392 DOI: 10.1007/bf02730724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The respiratory tract is the most common organ involved with Aspergillosis in children with hematologic malignancies. Also Aspergillus species tend to invade blood vessels resulting in systemic dissemination to multiple organs. Early diagnosis and treatment are pivotal to the patient's outcome. A high index of suspicion should be maintained in children who have profound neutropenia and present with prolonged fever that is unresponsive to systemic antibiotics. Several diagnostic modalities should be used simultaneously in order to confirm the diagnosis in an expedited manner. Combination and sequential antifungal therapy have been shown to be of added benefit. Surgical intervention is associated with a high mortality rate, but may be indicated in children with a localized disease. In this article the authors review the epidemiology, microbiology, pathology, and clinical manifestations of invasive aspergillosis in children with hematologic malignancies. Current diagnostic approach, medical, and surgical treatment options are discussed.
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Affiliation(s)
- Walid Abuhammour
- Pediatric Infectious Disease, Hurley Medical Center, Michigan State University, Hurley Medical Center, Flint, Michigan 48503, USA.
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28
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Cahill AM, Baskin KM, Kaye RD, Fitz CR, Towbin RB. CT-guided Percutaneous Lung Biopsy in Children. J Vasc Interv Radiol 2004; 15:955-60. [PMID: 15361563 DOI: 10.1097/01.rvi.0000130814.63277.f2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To describe techniques and evaluate outcomes of computed tomography (CT)-guided percutaneous lung biopsy in children. MATERIALS AND METHODS Between April 1992 and June 2003, 64 patients (32 male, 32 female) with a mean age of 10.8 years (0.6-20 years) were referred for 75 lung biopsies. Most biopsies were performed for suspected malignancy (n = 24; 32%) or to distinguish posttransplantation lymphoproliferative disorder from fungal infection in immunocompromised patients (n = 17; 23%). All children referred to the pediatric interventionalists in two children's hospitals for CT-guided biopsy of parenchymal or pleural-based lesions in the thorax were studied. Prospectively gathered procedural data were reviewed for medical history and indications for procedure, admission status, type of anesthesia, technical approach (core vs aspiration biopsy), procedural modifications, lesion size, number of passes required, and immediate complications. Medical records were retrospectively reviewed for diagnostic outcome, impact on patient management, and delayed complications. RESULTS Procedures were performed under deep sedation whenever possible (n = 61; 81%) with use of a coaxial core biopsy technique (n = 56; 75%), a fine needle aspiration biopsy technique (n = 15; 20%), or both (n = 4; 5%). Mean lesion diameters were 2.5 cm (range, 1-10 cm) in the core biopsy group and 1.0 cm (range, 0.5-1.7 cm) in the aspiration biopsy group. Sixty-four biopsies (85%) were diagnostic. There was one major complication (1.3%), a tension pneumothorax treated with intraprocedural placement of a chest tube. CONCLUSION Percutaneous CT-guided lung biopsy is a safe and accurate diagnostic procedure in children that obviates open surgical biopsy in most patients.
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Affiliation(s)
- Anne Marie Cahill
- Department of Radiology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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29
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Abstract
Pediatric interventions for oncology patients include aspiration or percutaneous biopsy for malignancy diagnosis or recurrence, and percutaneous biopsy for the complications of tumor treatment. Tumor localization techniques have been used to resect small lesions with minimal invasion. However improved guidance techniques have allowed for more precise biopsy and the use of thermal ablation instead of excision for local tumor control. I will discuss these diagnostic and therapeutic techniques as they apply to children.
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Affiliation(s)
- Fredric A Hoffer
- Division of Diagnostic Imaging, Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
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30
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Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H, Pointon K, Richardson C, Sawicka E. Guidelines for radiologically guided lung biopsy. Thorax 2003; 58:920-36. [PMID: 14586042 PMCID: PMC1746503 DOI: 10.1136/thorax.58.11.920] [Citation(s) in RCA: 276] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A Manhire
- Department of Radiology, Nottingham City Hospital, UK.
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31
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Hoffer FA. Reply to Thomas et al.: The radiological spectrum of invasive aspergillosis in children: a 10-year review. Pediatr Radiol 2003; 33:818. [PMID: 12961045 DOI: 10.1007/s00247-003-1047-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2003] [Revised: 07/15/2003] [Accepted: 07/21/2003] [Indexed: 10/26/2022]
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32
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Gow KW, Hayes-Jordan AA, Billups CA, Shenep JL, Hoffer FA, Davidoff AM, Rao BN, Schropp KP, Shochat SJ. Benefit of surgical resection of invasive pulmonary aspergillosis in pediatric patients undergoing treatment for malignancies and immunodeficiency syndromes. J Pediatr Surg 2003; 38:1354-60. [PMID: 14523819 DOI: 10.1016/s0022-3468(03)00395-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate the outcome of children undergoing treatment for malignancy and immunodeficiency syndromes in whom invasive pulmonary aspergillosis (IPA) developed. METHODS The authors reviewed the medical records of all patients treated at their institution from January 1990 to August 1999 for culture-proven pulmonary aspergillus infection. RESULTS Among the 43 patients studied, the median age at the time of diagnosis of IPA was 13.1 years. The most common primary diagnoses were acute myelogenous leukemia (n = 18) and acute lymphoblastic leukemia (n = 14); 27 patients (63%) had received a bone marrow transplant (BMT). Of the 18 patients who underwent surgical intervention for IPA, 14 (78%) had one operation, whereas the remaining 4 patients had 2. The 4 patients alive at the time this report was written had undergone surgical intervention 2, 10, 23, and 44 months previously respectively. Surgical resection of the involved lung parenchyma was significantly prognostic for survival (P <.001). Other factors that influenced outcome were the extent of pulmonary invasion, steroid use, and the timing of bone marrow transplantation (BMT) in regard to the diagnosis of IPA. CONCLUSIONS The overall mortality rate of children treated for malignancies and immunodeficiency syndromes in who IPA develops remains high, and antifungal therapy alone may not be curative. Surgical resection may provide a small but possibly the only chance for survival. Therefore, we would advocate for resection of all involved tissue, even if it requires reoperation.
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Affiliation(s)
- Kenneth W Gow
- Department of Surgery, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA
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33
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Abstract
Fungi are ubiquitous in the environment. Opportunistic fungal pneumonias in the immunocompromised host continue to increase most commonly due to Aspergillus sp. Affected patients are usually hematopoietic stem cell and lung transplant recipients. Clinical presentation is protean, and the diagnosis is challenging. Culture of respiratory specimens has limited utility. The detection of circulating fungal antigens and DNA seems promising, but more studies are needed. Value of prophylactic strategies or preemptive therapy remains contentious. New antifungal drugs for managing invasive pulmonary aspergillosis continue to emerge, with better safety, efficacy, and pharmacologic profiles.
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Affiliation(s)
- Remzi Bag
- Baylor College of Medicine, Houston, Texas, USA.
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34
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Hayes-Jordan A, Connolly B, Temple M, Chait P, Weitzman S, Njere I, Langer JC, Kim P. Image-guided percutaneous approach is superior to the thoracoscopic approach in the diagnosis of pulmonary nodules in children. J Pediatr Surg 2003; 38:745-8. [PMID: 12720185 DOI: 10.1016/jpsu.2003.50198] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND/PURPOSE Image-guided, percutaneous techniques are increasingly used in diagnosis of pulmonary disease in children. The aim of this study was to determine the diagnostic accuracy and clinical outcomes of thoracoscopic versus percutaneous lung biopsy in children. METHODS Sixty-three consecutive patients from January 1996 to December 2000 who had a thoracoscopic lung biopsy, a percutaneous ultrasound scan, or computed tomography (CT)-guided lung biopsy for well-defined and ill-defined lesions were analyzed. RESULTS Twenty-eight patients had a thoracoscopic lung biopsy (TLB), and 35 patients had a percutaneous image-guided lung biopsy (PLB). Age ranged from 6 months to 17 years (median, 8 years). There was no significant difference between groups with regard to age, depth of lung nodule biopsied, or prebiopsy diagnoses. Seventeen patients (60%) of TLB and 23 (65%) of PLB had well-defined pulmonary nodules suspicious for malignancy at the time of biopsy. Adequate tissue for pathologic diagnosis was obtained in 28 (100%) of TLB versus 26 (80%) of PLB patients. However, 8 (28%) thoracoscopic cases needed to be converted to an open procedure. In 3 (8.5%) PLB cases the percutaneous biopsy was insufficient, and a thoracoscopic or open biopsy was required. The median hospital stay was 3 days for TLB and 4 to 6 hours for PLB (P =.023). There were no complications in the PLB group. Five (18%) of TLB patients suffered a persistent air leak treated with continued chest tube drainage, and one patient died of other causes with a persistent air leak. CONCLUSIONS Percutaneous lung biopsy has a significantly shorter hospital stay and a lower complication rate than thoracoscopic lung biopsy. The authors propose that the percutaneous technique should be considered as the initial approach for children with pulmonary nodules.
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35
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Abstract
Invasive pulmonary aspergillosis is the most common fungal pulmonary infection in certain immunocompromised patients. The most commonly affected patients are hematopoietic stem cell transplant recipients and patients with hematological malignancies undergoing intensive chemotherapy. The survival of patients with invasive pulmonary aspergillosis is very poor because of difficulties in early diagnosis and lack of effective treatment options. Research efforts are being made constantly to improve different diagnostic techniques. Early, repeated, high resolution computed tomography of the chest, and sequential nonculture-based monitoring of Aspergillus antigen and DNA can improve earlier diagnosis. New antifungal drugs for treatment and prevention of invasive pulmonary aspergillosis continue to emerge, with better safety, efficacy, and pharmacologic profiles.
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Affiliation(s)
- Ilana Oren
- Infectious Diseases Unit, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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36
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37
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