Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Nocardiosis
- Radiologic Findings
- Contrast-enhanced chest CT images showed several subpleural nodules and consolidation with internal low density at both lower lobes. Enlarged paraaotic lymph nodes with internal necrosis were also noted. Contrast-enhanced brain MR images demonstrated a small peripheral enhancing lesion at the left parietal lobe, suggesting a microabscess.
- Brief Review
- Nocardia is an aerobic gram (+) bacilli which causes pneumonia in patients with deficits in cell-mediated immunity such as those with AIDS, transplant recipients, and receiving corticosteroid therapy. Pulmonary nocardiosis can present with signs and symptoms similar to those of pulmonary tuberculosis such as fever, chills, fatigue, dyspnea, productive cough, hemoptysis, sweats, and weight loss. Disseminated nocardiosis occurs through hematogenous spread from the lungs most commonly to the CNS, skin, and joints.
On chest CT images, multifocal lung consolidation with decreased attenuation, and possible cavitation is the predominant finding. Nocardiosis can also manifest as nodules and masses, pleural or chest wall involvement due to direct extension. Differential diagnosis for pulmonary nocardiosis includes other causes of lung consolidation, cavitation, and nodules such as other infections, vasculitis, and malignancy. Actinomycosis can have similar CT appearance to that of Nocardia, but actinomycosis does not become disseminated to involve the CNS.
Treatment for pulmonary nocardiosis is sulfa-containing antibiotics, and possible surgery or drainage for extensive lung destruction.
- Please refer to
Case 76, Case 117, Case 549, Case 630, -
KSTR Imaging Conference 2011 Summer Case 3
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KSTR Imaging Conference 2008 Summer Case 6
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KSTR Imaging Conference 2002 Spring Case 4
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KSTR Imaging Conference 2001 Spring Case 11
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KSTR Symposium 1999 Case 8
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KSTR Symposium 1998 Case 10,
- References
- 1. Kanne JP, Yandow DR, Mohammed TL et-al. CT findings of pulmonary nocardiosis. AJR Am J Roentgenol. 2011;197 (2): W266-72.
2. Rosado-de-christenson: Diagnostic imaging. Chest. 2010; 4:38-39
- Keywords
- Lung, Mediastinum, Infection, Bacterial infection,