Color Doppler sonography of pulmonary aspergillosis in infants with chronic granulomatous disease

Background: Pulmonary aspergillosis may be the first presentation of chronic granulomatous disease (CGD) and may occur during infancy. Imaging studies with plain chest radiographs and computed tomography may present a diagnostic challenge, and high index of suspicion is required for the diagnosis.

Objective: Report a six-week-old boy with chronic granulomatous disease and invasive pulmonary aspergillosis, in who color Doppler sonography of the chest showed systemic arterial supply to the pulmonary lesions.

Methods: Sonography of the chest using a high-frequency linear transducer was performed in a six-week-old infant with chronic granulomatous disease who presented with noisy breathing, cough, and low-grade fever, and his chest radiograph revealed multiple sites of pulmonary opacities.

Results: The peripheral pulmonary nodules had low-resistant arterial supply derived from a systemic artery of the chest wall. The pulmonary lesion was later proven to be fungal infection. Similar imaging was detected in another two infants with the same disease.

Conclusion: Systemic arterial supply could develop to feed peripheral pulmonary aspergillosis in an infant as young as six-week old who had underling CGD.