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Infectious and Non-Infectious Diseases Causing the Air Crescent Sign: A State-of-the-Art Review

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Abstract

Aspergilloma, also known as mycetoma or fungus ball, is characterized by a round or oval mass with soft-tissue attenuation within a preexisting lung cavity. The typical computed tomography (CT) aspect of an aspergilloma is a mass separated from the wall of the cavity by an airspace of variable size and shape, resulting in the air crescent sign, also known as the meniscus sign. This CT feature is non-specific and can be simulated by several other entities that result in intracavitary masses. This review describes the main clinical and imaging aspects of the infectious and non-infectious diseases that may present with fungus-ball appearance, including pulmonary hydatid cyst, Rasmussen aneurysm, pulmonary gangrene, intracavitary clot, textiloma, lung cancer, metastasis, and teratoma, focusing on the differential diagnosis.

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References

  1. Knower MT, Kavanagh P, Chin R Jr (2002) Intracavitary hematoma simulating mycetoma formation. J Thorac Imaging 17:84–88

    Article  PubMed  Google Scholar 

  2. Yasuda M, Nagashima A, Haro A, Saitoh G (2013) Aspergilloma mimicking a lung cancer. Int J Surg Case Rep 4:690–692

    Article  PubMed  PubMed Central  Google Scholar 

  3. Marchiori E, Zanetti G, Barreto MM (2015) Teratoma: another cause of the aircrescent sign. QJM 108:431

    Article  CAS  PubMed  Google Scholar 

  4. Fred HL, Gardiner CL (2009) The air crescent sign: causes and characteristics. Tex Heart Inst J 36:264–265

    PubMed  PubMed Central  Google Scholar 

  5. Franquet T, Müller NL, Giménez A, Guembe P, de La Torre J, Bagué S (2001) Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics 21:825–837

    Article  CAS  PubMed  Google Scholar 

  6. Latgé JP (1999) Aspergillus fumigatus and aspergillosis. Clin Microbiol Rev 12:310–350

    PubMed  PubMed Central  Google Scholar 

  7. Gazzoni FF, Severo LC, Marchiori E, Guimarães MD, Garcia TS, Irion KL et al (2014) Pulmonary diseases with imaging findings mimicking aspergilloma. Lung 192:347–357

    Article  PubMed  Google Scholar 

  8. Gazzoni FF, Hochhegger B, Severo LC, Marchiori E, Pasqualotto A, Sartori AP et al (2014) High-resolution computed tomographic findings of Aspergillus infection in lung transplant patients. Eur J Radiol 83:79–83

    Article  PubMed  Google Scholar 

  9. Louza GF, Zanetti G, Marchiori E (2017) Aspergilloma in honeycomb cysts and paraseptal emphysema: an unusual association. Arch Bronconeumol. https://doi.org/10.1016/j.arbres.2017.06.027

    Google Scholar 

  10. Roberts CM, Citron KM, Strickland B (1987) Intrathoracic aspergilloma: role of CT in diagnosis and treatment. Radiology 165:123–128

    Article  CAS  PubMed  Google Scholar 

  11. Thompson BH, Stanford W, Galvin JR, Kurihara Y (1995) Varied radiologic appearances of pulmonary aspergillosis. Radiographics 15:1273–1284

    Article  CAS  PubMed  Google Scholar 

  12. Marchiori E, Hochhegger B, Zanetti G (2016) Intracavitary nodule. J Bras Pneumol 42:309

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sakarya ME, Özbay B, Yalcinkaya İ, Arslan H, Uzun K, Poyraz N (1998) Aspergillomas in the lung cavities. East J Med 3:7–9

    Google Scholar 

  14. Abramson S (2001) The air crescent sign. Radiology 218:230–232

    Article  CAS  PubMed  Google Scholar 

  15. Malik A, Chandra R, Prasad R, Khanna G, Thukral BB (2016) Imaging appearances of atypical hydatid cysts. Indian J Radiol Imaging 26:33–39

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gouliamos AD, Kalovidouris A, Papailiou J, Vlahos L, Papavasiliou C (1991) CT appearance of pulmonary hydatid disease. Chest 100:1578–1581

    Article  CAS  PubMed  Google Scholar 

  17. Lewall DB (1998) Hydatid disease: biology, pathology, imaging and classification. Clin Radiol 53:863–874

    Article  CAS  PubMed  Google Scholar 

  18. Koul PA, Koul AN, Wahid A, Mir FA (2000) CT in pulmonary hydatid disease: unusual appearances. Chest 118:1645–1647

    Article  CAS  PubMed  Google Scholar 

  19. Garg MK, Sharma M, Gulati A, Gorsi U, Aggarwal AN, Agarwal R et al (2016) Imaging in pulmonary hydatid cysts. World J Radiol 8:581–587

    Article  PubMed  PubMed Central  Google Scholar 

  20. Balikian JP, Mudarris FF (1974) Hydatid disease of the lungs. A roentgenologic study of 50 cases. Am J Roentgenol Radium Ther Nucl Med 122:692–707

    Article  CAS  PubMed  Google Scholar 

  21. Flynn JL, Chan J (2001) Tuberculosis: latency and reactivation. Infect Immun 69:4195–4201

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Ruffino-Netto A (2002) Tuberculosis: the neglected calamity. Rev Soc Bras Med Trop 35:51–58

    Article  PubMed  Google Scholar 

  23. Manzella A, Filho PB, Albuquerque E, Farias F, Kaercher J (2009) Imaging of gossypibomas: pictorial review. AJR Am J Roentgenol 193:S94–S101

    Article  PubMed  Google Scholar 

  24. Domingos-Grando R, Zanetti G, Marchiori E (2016) Hemoptysis in tuberculosis: the importance of contrast-enhanced computed tomography. Arch Bronconeumol 52:173–174

    Article  PubMed  Google Scholar 

  25. Keeling AN, Costello R, Lee MJ (2008) Rasmussen’s aneurysm: a forgotten entity? Cardiovasc Intervent Radiol 31:196–200

    Article  CAS  PubMed  Google Scholar 

  26. Marchiori E, Hochhegger B, Zanetti G (2015) Intracavitary nodule in active tuberculosis: differential diagnosis of aspergilloma. J Bras Pneumol 41:562–563

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wang W, Gao L, Wang X (2013) Rasmussen’s aneurysm with aspergilloma in old, healed pulmonary tuberculosis. Clin Imaging 37:580–582

    Article  PubMed  Google Scholar 

  28. Castañer E, Gallardo X, Rimola J, Pallardó Y, Mata JM, Perendreu J et al (2006) Congenital and acquired pulmonary artery anomalies in the adult: radiologic overview. Radiographics 26:349–371

    Article  PubMed  Google Scholar 

  29. Penner C, Maycher B, Long R (1994) Pulmonary gangrene. A complication of bacterial pneumonia. Chest 105:567–573

    Article  CAS  PubMed  Google Scholar 

  30. Gold W, Vellend H, Brunton J (1992) The air crescent sign caused by Staphylococcus aureus lung infection in a neutropenic patient with leukemia. Ann Intern Med 116:910–911

    Article  CAS  PubMed  Google Scholar 

  31. Zelefsky MN, Lutzker LG (1977) The target sign: a new radiologic sign of septic pulmonary emboli. AJR Am J Roentgenol 129:453–455

    Article  CAS  PubMed  Google Scholar 

  32. Reich JM (1993) Pulmonary gangrene and the air crescent sign. Thorax 48:70–74

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Castaner E, Gallardo X, Mata JM (1998) Common and uncommon complications of reactivation tuberculosis in immunocompetent patients. Eur J Radiol 27:43–52

    Article  CAS  PubMed  Google Scholar 

  34. Yella LK, Krishnan P, Gillego V (2005) The air crescent sign: a clue to the etiology of chronic necrotizing pneumonia. Chest 127:395–397

    Article  PubMed  Google Scholar 

  35. Vlaović J, Voga G (2016) Spontaneous pulmonary hematoma in a patient with sepsis treated with dual antiplatelet therapy. Wien KlinWochenschr 128:553–556

    Article  Google Scholar 

  36. Bard R, Hassani N (1975) Crescent sign in pulmonary hematoma. Respiration 32:247–251

    Article  CAS  PubMed  Google Scholar 

  37. Shorr RM, Crittenden M, Indeck M, Hartunian SL, Rodriguez A (1987) Blunt thoracic trauma. Analysis of 515 patients. Ann Surg 206:200–205

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Rijken MJ, van Overbeeke AJ, Staaks GH (2005) Gossypiboma in a man with persistent cough. Thorax 60:708

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Nomori H, Horio H, Hasegawa T, Naruke T (1996) Retained sponge after thoracotomy that mimicked aspergilloma. Ann Thorac Surg 61:1535–1536

    Article  CAS  PubMed  Google Scholar 

  40. Machado DM, Zanetti G, Araujo Neto CA, Nobre LF, Meirelles GSP, Pereira-Silva JL et al (2014) Thoracic Textilomas. Computed tomography findings. J Bras Pneumol 40:535–542

    Article  PubMed  PubMed Central  Google Scholar 

  41. Nobre LF, Zanetti G, Marchiori E (2016) Textiloma: a forgotten diagnosis. Rev Port Pneumol 22:366–367

    PubMed  Google Scholar 

  42. Marchiori E, Zanetti G, Hochhegger B, Machado DM (2011) Hydatid disease versus textiloma: a diagnostic challenge. Thorax 66:635

    Article  PubMed  Google Scholar 

  43. Alberg AJ, Samet JM (2003) Epidemiology of lung cancer. Chest 123:21S–49S

    Article  PubMed  Google Scholar 

  44. Park Y, Kim TS, Yi CA, Cho EY, Kim H, Choi YS (2007) Pulmonary cavitary mass containing a mural nodule: differential diagnosis between intracavitary aspergilloma and cavitating lung cancer on contrast-enhanced computed tomography. Clin Radiol 62:227–232

    Article  CAS  PubMed  Google Scholar 

  45. Chaudhuri MR (1970) Cavitary pulmonary metastases. Thorax 25:375–381

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Guimaraes MD, Hochhegger B, Santos MK, Santana PR, Júnior Sousa AS et al (2015) Magnetic resonance imaging of the chest in the evaluation of cancer patients: state of the art. Radiol Bras 2015(48):33–42

    Article  Google Scholar 

  47. Bandoh S, Fujita J, Fukunaga Y, Yokota K, Ueda Y, Okada H et al (1999) Cavitary lung cancer with an aspergilloma-like shadow. Lung Cancer 26:195–198

    Article  CAS  PubMed  Google Scholar 

  48. Goto T, Kato R, Maeshima A, Oyamada Y (2010) Cavitary lung cancer with an aspergilloma-like shadow. J Thorac Oncol 5:580–581

    Article  PubMed  Google Scholar 

  49. Cavalcante BF, Zanetti G, Marchiori E (2015) Pulmonary neoplasia mimicking fungus ball. Radiol Bras 48:400–401

    Article  PubMed  PubMed Central  Google Scholar 

  50. Seo JB, Im JG, Goo JM, Chung MJ, Kim MY (2001) Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics 21:403–417

    Article  CAS  PubMed  Google Scholar 

  51. Watanabe H, Uruma T, Tsunoda T, Tazaki G, Suga A, Nakamura Y et al (2014) Lung metastasis of transitional cell cancer of the urothelium, with fungus ball-like shadows closely resembling aspergilloma: a case report and review of the literature. Oncol Lett 8:95–98

    Article  PubMed  PubMed Central  Google Scholar 

  52. Gaeta M, Volta S, Scribano E, Loria G, Vallone A, Pandolfo I (1996) Air-space pattern in lung metastasis from adenocarcinoma of the GI tract. J Comput Assist Tomogr 20:300–304

    Article  CAS  PubMed  Google Scholar 

  53. Barreto MM, Valiante PM, Zanetti G, Boasquevisque CH, Marchiori E (2015) Intrapulmonary mature teratoma mimicking a fungus ball. Lung 193:443–445

    Article  PubMed  Google Scholar 

  54. Giunchi F, Segura JJ (2012) Primary malignant teratoma of lung: report of a case and review of the literature. Int J Surg Pathol 20:523–527

    Article  PubMed  Google Scholar 

  55. Makarawo TP, Finnikin S, Woolley S, Bishay E (2009) Trichoptysis: a hairy presentation of a rare tumour. Interact Cardiovasc Thorac Surg 9:733–735

    Article  PubMed  Google Scholar 

  56. Roig J, Aguilar X, Maestre J, Domingo C, Morera J (1991) Pulmonary mass and air meniscus sign in a 19-year-old man. Chest 100:562–563

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Edson Marchiori.

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Sevilha, J.B., Rodrigues, R.S., Barreto, M.M. et al. Infectious and Non-Infectious Diseases Causing the Air Crescent Sign: A State-of-the-Art Review. Lung 196, 1–10 (2018). https://doi.org/10.1007/s00408-017-0069-3

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  • DOI: https://doi.org/10.1007/s00408-017-0069-3

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