Radiological diagnoses and follow-up of chronic pulmonary aspergillosis (CPA)

Any features of cavitation,  fungal ball, pleural  thickening and/or upper  lobe fibrosisRaise suspicion of CPA for physiciansRadiological report must mention possible CPAAII[10, 11, 24, 25, 40, 55, 56]CPA is often missed for years and patients mismanaged; microbiological testing required for confirmation
Suspicion of CPA on chest  radiographDiagnosis or exclusion of CPACT scan (contrast)AII[55]High quality CT with vessel visualisation
PET scanDIII[57, 58]Expert radiology advice
Follow-up on or off  therapyCT (low dose)BIII[15, 55]General need to minimise radiation exposure, especially multiple CT scans
Chest radiographBIII
Initial follow-up at 3 or 6 months or with change of statusAII[15, 59]
  • SoR: strength of recommendation; QoE: quality of evidence; CT: computed tomography; PET: positron emission tomography.