Computed tomography findings of pneumonia resistant to empirical therapy in patients with hematologic diseases

TL;DR

This study examines CT scan features of pneumonia in patients with blood disorders that does not respond to standard treatments, finding patterns similar to airway inflammation.

Contribution

The study identifies CT patterns in hematologic patients with treatment-resistant pneumonia, emphasizing the need for bronchoalveolar lavage.

Findings

Pneumonia in hematologic patients often shows bilateral lung involvement and no field predominance.

Common CT features include consolidation, bronchial wall thickening, and bronchiectasis.

Extrapulmonary findings were rare, occurring in less than 27% of patients.

Abstract

To investigate computed tomography (CT) features of pneumonia that does not
respond to empirical therapy in patients with hematologic diseases.

This was a retrospective analysis of all patients with hematologic disease
who were diagnosed with pneumonia between 2017 and 2023, did not respond to
empirical therapy for the infection, and underwent bronchoalveolar lavage
and CT within a week of each other. The distribution and CT pattern of
pulmonary abnormalities were assessed, as was the presence of
lymphadenopathy, pleural effusion, and pericardial effusion.

Forty-nine patients (30 males; mean age, 61 years) were included. We
identified Gram-negative bacteria in 45 patients, Gram-positive bacteria in
13, and fungi in three. Pulmonary abnormalities were bilateral in 73% of the
patients in the sample, and there was no difference in prevalence between
the upper and lower lung fields in 53%. Common alterations were
consolidation, in 73% of the patients, bronchial wall thickening, in 71%,
bronchiectasis, in 55%, and nodules, in 53%; extrapulmonary findings were
less common, being identified in ≤ 27%. Pulmonary findings were
typically bilateral and without a predominance between the upper and lower
lung fields (p < 0.05). Common associations were between
consolidation and bronchiectasis, between nodules and bronchial wall
thickening, and between bronchiectasis and bronchial wall thickening
(p < 0.05 for all).

The CT manifestations of pneumonia in patients with hematologic diseases not
responding to empirical therapy can resemble those of lobular pneumonia with
airway inflammation. For that reason, as well as because multiple pathogens
can be present in the same patient, examination of bronchoalveolar lavage
fluid can be necessary.

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