IntroductionThe important role of radiological examinations of invasive pulmonary aspergillosis (IPA) in patients with neutropenia has been well studied; however, little is known about IPA in critically ill chronic obstructive pulmonary disease (COPD) patients. ObjectivesTo evaluate the value of radiological examinations in the diagnosis and prognosis of invasive bronchial-pulmonary aspergillosis (IBPA) in critically ill COPD patients. MethodsWe included 61 critically ill COPD patients in the intensive care unit (ICU) in a retrospective, single-center cohort study. ResultsAll of the patients were classified as IBPA group (n=21) or non-IBPA group (n=40). The chest computed tomography (CT) image analysis showed that the IBPA group had the highest percent of patchiness (76.2%), followed by multiple nodules (33.3%), angio-invasive patterns (including halo sign, wedge consolidation and air-crescent sign/cavity with a relatively low percent of 19%, 19% and 28.5%, respectively), and the multiple nodules that were distributed along the airway provided the most specific image, with the highest specificity of 92.5%. Compared to the survivors in the IBPA group, non-surviving patients had a higher percent of large consolidation (0% vs. 45.5%, P=.035). When the new effusions appeared on a chest x-ray (CXR), the creatinine (140.4 mol/L vs. 64.0 mol/L, P=.010) and PaO2/FiO(2) (188 mm Hg vs. 222 mm Hg, P=.034) rate deteriorated. ConclusionsMultiple nodules that were distributed along with broncho-vascular bundles were relatively common and specific in critically ill COPD patients with IBPA. Deteriorated CXR combined with specific laboratory examinations, even when appropriate antibiotics were used, could indicate a diagnosis of IBPA. Large consolidations might be considered as poor prognostic indicators.