Algorithmic Approach to an Abnormal Computed Tomography of the Chest in the Immunocompromised Host - 30/01/25

Doi : 10.1016/j.ccm.2024.10.001

Priyanka Makkar, MD, FCCP ^a, Diane Stover, MD ^b, Jane P. Ko, MD ^c, Stephen C. Machnicki, MD, FCCP ^d,^e, Alain Borczuk, MD ^f,^g, Suhail Raoof, MD, Master FCCP, MACP, FCCM ^h,^i,^j,^k,^⁎
^a Advanced Lung Diseases and Lung Transplant, Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital/Northwell Health, New York, NY 10075, USA
^b Department Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
^c Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, 660 First Avenue, 3rd Floor, New York, NY 10016, USA
^d Department of Radiology, Donald, and Barbara Zucker School of Medicine at Hofstra/Northwell
^e Department of Radiology, Lenox Hill Hospital, 100 East 77th Street, New York, NY 10075, USA
^f Department of Pathology, Northwell Health
^g Donald and Barbara Zucker School of Medicine, 500 Hofstra University, Hempstead, NY 11549, USA
^h Lung Institute, Northwell Health
ⁱ Department of Pulmonary, Critical Care & Sleep Medicine, Lenox Hill Hospital, 100 East 77th Street, New York, NY 10075, USA
^j Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
^k Northwell Health System, NY, USA

^∗Corresponding author. Lung Institute, Northwell Health, Department of Pulmonary, Critical Care and Sleep Medicine, Lenox Hill Hospital, 100 East 77th Street, New York, NY 10075.Lung InstituteNorthwell HealthDepartment of PulmonaryCritical Care and Sleep MedicineLenox Hill Hospital100 East 77th StreetNew YorkNY10075

Résumé

The immunocompromised host is a patient who is at risk for life threatening complications. This article offers a structured approach to interpreting abnormal chest computed tomography (CT) scans in these patients. Immune defects are categorized as innate or adaptive and each is linked to specific infectious risks. CT scan findings are grouped into 5 categories: nodules and/or masses, consolidation or ground glass opacity, large airway abnormalities, pleural effusions, and lymphadenopathy. This algorithmic approach can guide clinicians in establishing a differential diagnosis for immunocompromised patients with abnormal chest CT scans and help them reach a faster and more accurate diagnosis.

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Keywords : Immunocompromised patients, Abnormal computed tomography chest, Hematologic malignancy, Hematopoietic stem cell transplant, Solid organ transplant