COMPUTED TOMOGRAPHY ASSESSMENT OF PULMONARY ASPERGILLOSIS: IMAGING PHENOTYPES AND DIAGNOSTIC CORRELATION IN A MACEDONIAN CLINICAL COHORT
COMPUTED TOMOGRAPHY ASSESSMENT OF PULMONARY ASPERGILLOSIS: IMAGING PHENOTYPES AND DIAGNOSTIC CORRELATION IN A MACEDONIAN CLINICAL COHORT

Summary/Abstract: Pulmonary aspergillosis comprises a diverse set of fungal disorders with radiologic features influenced by immune status and pre-existing pulmonary architecture. In clinical scenarios where tuberculosis-related structural damage and chronic immunosuppression coexist, computed tomography (CT) plays a central role in raising early diagnostic suspicion and guiding further evaluation. This article presents a single-centre clinical-imaging analysis of patients with confirmed pulmonary aspergillosis managed at a tertiary radiology institution in North Macedonia, with particular focus on CT phenotypes and their diagnostic relevance. Distinct imaging patterns were observed across the cohort, including intracavitary fungal colonization within chronic post-tuberculous cavities, progressive cavitary and paracavitary changes suggestive of semi-invasive disease, and nodular or halo-type lesions correlating with angioinvasion in immunocompromised individuals. CT-based pattern recognition enabled stratification of cases along a spectrum ranging from saprophytic colonization to invasive fungal infection, facilitating targeted microbiologic testing and interventional procedures. Beyond individual diagnostic utility, these findings highlight the broader significance of local epidemiology, as structurally altered lungs provided a permissive substrate for colonization in the majority of patients. Recognition of such CT phenotypes may improve diagnostic confidence, reduce delays in antifungal therapy, and support multidisciplinary management in regions where fungal disease overlaps with chronic pulmonary pathology

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