ABSTRACT
Aspergillus pulmonary infection causes a spectrum of diverse diseases according to host immunity. The two major entities are invasive pulmonary aspergillosis and chronic pulmonary aspergillosis. The later can be divided into aspergilloma, then into chronic cavitary, more or less fibrosing aspergillosis, and finally into chronic necrotizing aspergillosis, or semiinvasive aspergillosis. The present article reviews this complex classification, which is necessary to reflect the diverse clinical aspect of the disease. Allergic broncho-pulmonary aspergillosis (ABPA), which is more a hypersensitivity reaction than an infectious process, will not be discussed here.
Subject(s)
Invasive Pulmonary Aspergillosis/classification , Pulmonary Aspergillosis/classification , Aspergillosis, Allergic Bronchopulmonary/classification , Aspergillosis, Allergic Bronchopulmonary/diagnosis , Aspergillosis, Allergic Bronchopulmonary/therapy , Chronic Disease , Diagnosis, Differential , Humans , Invasive Pulmonary Aspergillosis/diagnosis , Invasive Pulmonary Aspergillosis/therapy , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/therapyABSTRACT
Numerous respiratory disorders may be responsible for right heart dysfunction, frequently suboptimally assessed in routine clinical practice. Multidetector-row CT systems with fast scanning capabilities can acquire images of the thorax with reduced cardiac motion artifacts, enabling improved evaluation of the heart. Moreover, the introduction of fast rotation speed and dedicated cardiac reconstruction algorithms exploiting the multislice acquisition scheme of the data has opened the possibility of integrating right cardiac functional information into a diagnostic CT scan of the chest, without or with ECG gating.
Subject(s)
Angiography/methods , Heart Diseases/diagnostic imaging , Heart/diagnostic imaging , Hypertension, Pulmonary/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Radiography, Thoracic , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Algorithms , Electrocardiography , Female , Foramen Ovale/diagnostic imaging , Humans , Image Processing, Computer-Assisted , Male , Middle AgedABSTRACT
OBJECTIVES: To assess the prevalence and patterns of cardiac abnormalities as detected by cardiac magnetic resonance imaging (MRI) in systemic sclerosis (SSc). METHODS: Fifty-two consecutive patients with SSc underwent cardiac MRI to determine morphological, functional, perfusion at rest and delayed enhancement abnormalities. RESULTS: At least one abnormality on cardiac MRI was observed in 39/52 patients (75%). Increased myocardial signal intensity in T2 was observed in 6 patients (12%), thinning of left ventricle (LV) myocardium in 15 patients (29%) and pericardial effusion in 10 patients (19%). LV and right ventricle (RV) ejection fractions were altered in 12 patients (23%) and 11 patients (21%), respectively. LV diastolic dysfunction was found in 15/43 patients (35%). LV kinetic abnormalities were found in 16/52 patients (31%) and myocardial delayed contrast enhancement was detected in 11/52 patients (21%). No perfusion defects at rest were found. Patients with limited SSc had similar MRI abnormalities to patients with diffuse SSc. Seven of 40 patients (17%) without pulmonary arterial hypertension had RV dilatation. CONCLUSIONS: This study shows that MRI is a reliable and sensitive technique for diagnosing heart involvement in SSc and for analysing its mechanisms, including its inflammatory, microvascular and fibrotic components. Compared with echocardiography, MRI appears to provide additional information by visualising myocardial fibrosis and inflammation. RV dilatation appeared to be non-specific for pulmonary arterial hypertension but could also reflect myocardial involvement related to SSc. Further studies are needed to determine whether cardiac MRI abnormalities have an impact on the prognosis and treatment strategy.
