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Fungal infections can have a wide variety of appearances,

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partially depending on the type of pathogen

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and also the immune competence.

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State of the patient.

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I will focus on a few here to get you started,

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but know that there can be overlapping features

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and differences amongst these different entities.

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First, we'll start with a patient

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with known immunocompromised who has relapsed A LL.

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We have a contrast enhanced soft tissue window axial CT scan

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here, and the first thing I'll do is

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change this to lung windows.

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And you'll notice in the right upper lobe

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that we have an area of some consolidation,

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more dense centrally

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with a slightly less dense periphery.

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This is typical of the halo sign

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that we can see in fungal infections that's often described

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with aspergillus, which is what this patient has.

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They have a type

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of aspergillus infection called angio invasive

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aspergillosis, and again, we see this halo sign

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of a consolidation as well as additional multifocal

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consolidation and ground glass opacities.

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A number of findings have been described

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with angio invasive aspergillosis, including this halo sign,

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which is due to hemorrhage surrounding the lesion.

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There's also the reversed halo

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or a toll sign, which we're not seeing in this patient,

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but where there's a more lucid center

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with a more hyperdense periphery.

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We also can see an air crescent sign, uh,

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if there's air surrounding the lesion

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or there can be areas of cavitation within consolidation.

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This same patient had a follow-up CT

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not too long afterwards.

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And on the soft tissue windows, we can immediately see areas

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of consolidation.

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We see a pleural effusion.

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We can change this to long windows

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and see the extent of disease Here where we have,

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particularly on the right side, a large amount

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of consolidation, ground glass opacities,

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and now we also have an air crescent sign around our lesion.

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We can also see

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how the infection has spread elsewhere throughout that lung

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and into the left lung with multifocal round glass

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and consolidative opacities in multiple regions.

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The next patient also has aspergillus.

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We have a CT scan here, axial cron

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and sagittal contrast enhanced images

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and we'll focus on the axial to start again.

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We see multifocal abnormalities

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to include ground glass opacities

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and consolidation, which probably some

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ectasis dependently as well.

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We also see tree and butt opacities scattered throughout.

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Importantly, we

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See a more focal area on the left side

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with a surrounding air crescent sign.

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So this is that typical fungus ball

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that we can sometimes see.

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This is a patient that had leukemia as well

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and uh, unfortunately got aspergillosis.

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Again, we see multiple findings,

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but this classic finding of a fungus ball

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with an air crescent sign in this patient.

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If we look at the other planes similarly,

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we can see multifocal abnormality

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and the fungus ball with the air crescent sign,

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and the same on the sagittal.

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Our final example of aspergillus is a patient

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who had autoimmune hepatitis and was immunosuppressed.

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We see here an axial sequence in lung windows

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and here we see multiple nodules with central cavitation

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throughout both lungs.

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And so this is another appearance of what

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aspergillus can look like.

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We don't see so much tree

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and butt opacities like we saw in our other two patients.