Boy with ALL and stem cell transplant is neutropenic and febrile.
Which choice depicts the most likely diagnosis?
CMV pneumonia.Septic emboli.Angioinvasive aspergillosis.Chloromas.GVH disease.
CT chest: Multiple varying sized nodular opacities throughout the right lung with a surrounding ground-glass halo.
CT Abdomen and pelvis: There is cecal and ascending colonic wall thickening and enhancement. The small bowel also appears to mildly enhance.
- Opportunistic fungal infection such as aspergillis
- Septic Emboli
- Lymphoma / metastases
- (In appropriate clinical setting) Necrotizing angiitis such as Wegeners.
- Graft vs host disease
- CMV colitis or inflammatory colitis
Chest: Presumed angioinvasive aspergillosis.
Abdomen: Presumed graft vs host disease. See the additional images below.Note enhancement of the esophageal mucosa and gallbladder wall enhancement with fatty infiltration of the liver.