대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Pulmonary cryptococcosis

Radiologic Findings

Figs 1. Chest AP shows air space consolidation in the left lung and nodular opacities in the right lung.
Fig 2-5. Chest CT scans show extensive consolidation with peripheral ground glass opacities in the left lung and multiple nodules, nodules with halos, and consolidation in the right lung.
Percutaneous needle aspiration biopsy was performed at the LUL. The pathologic diagnosis was cryptococcosis with chronic granulomatous inflammation (GMS, PAS: positive)

Brief Review

Cyptococcus neoformans is a thin-walled, nonmycelial, budding encapsulated yeast. It is found worldwide, particularly in soil contaminated with pigeon excreta and decayed wood . Human infection occurs via inhalation of cryptococcal particles into the lungs, although pneumonia is relatively uncommon in infected individuals.
Cryptococcal infections most commonly occur in immunocompromised hosts, such as those with acquired immunodeficiency syndrome, transplant-related immunosuppression, or hematologic malignancies. Immunocompetent individuals are infected less commonly.
According to Khoury et al. who compared the chest radiographic findings of immunocompetent and immunocompromised patients, they found a wider variety of radiographic abnormalities among immunocompromised patients. Specifically, areas of consolidation, lymphadenopathy, and pleural effusions occurred only in the immunocompromised patients. In addition, Sider and Westcott examined the CT scans of 10 patients with acquired immunodeficiency syndrome and pulmonary cryptococcosis and reported parenchymal opacities (n = 7), interstitial opacities (n = 5), segmental alveolar opacities (n = 5), multiple ill-defined spiculated nodules (n = 3), lymphadenopathy (n = 1), and small bilateral pleural effusions (n = 1). They found that patients with acquired immunodeficiency syndrome had a lower incidence of nodules (three of 10 vs nine of 10 in their study) and a higher incidence of other pulmonary parenchymal abnormalities than did their immunocompetent patients.
Lacomis et al. also reported a wider variety of imaging findings and a lower incidence of pulmonary nodules in 46 patients, only one of whom was immunocompetent. The most common finding in their study was an area of consolidation (n = 30).
Recently, Xie et al. reported a comparison of CT findings in immunocompetent and immunocompromised patients. In their report, pulmonary nodules/masses, either solitary or multiple, were the most common CT finding; associated findings included CT halo signs (n = 24), cavitations (n = 23), and air bronchograms (n = 17). Areas of consolidation (n = 14), areas of GGO (n = 13), linear opacities (n = 11), lymphadenopathies (n = 5), and pleural effusions (n = 8) were uncommon. The parenchymal abnormalities were peripherally located in 47 (65.2%) cases. Cavitations within nodules/masses were more frequently present in immunocompromised patients than in immunocompetent patients, and in AIDS patients than in non-AIDS immunocompromised patients. Air bronchograms within nodules/masses were more frequently present in immunocompetent patients than in immunocompromised patients. Nodules/masses with halo signs were less frequent in AIDS patients than in non-AIDS immunocompromised patients.

Please refer to

Case 181, Case 231, Case 282, Case 368, Case 382, Case 388, Case 446, Case 512, Case 671, Case 754, Case 770, Case 817, Case 831, Case 842, Case 891,

KSTR Imaging conference 2009 Summer  Case 16 ,
Thoracic Imaging 2003- Korean & Japanese Film Interpretation -  Case 5 ,
KSTR Imaging Conference 2001 Spring  Case 6,

References

1. Sider L, Westcott MA. Pulmonary manifestations of cryptococcosis in patients with AIDS: CT features. J Thorac Imaging 1994; 9: 78–84
2 Lacomis JM, Costello P, Vilchez R, et al. The radiology of pulmonary cryptococcosis in a tertiary medical center. J Thorac Imaging 2001; 16: 139–148.
3. Zinck SE, Leung AN, Frost M, et al. Pulmonary cryptococcosis: CT and pathologic findings. J Comput Assist Tomogr 2002; 26: 330–334.
4. Khoury MB, Godwin JD, Ravin CE, et al. Thoracic cryptococcosis: immunologic competence and radiologic appearance. AJR Am J Roentgenol 1984; 142: 893–896
5. Xie LX, Chen YS, Liu SY, Shi YX. Pulmonary cryptococcosis: comparison of CT
findings in immunocompetent and immunocompromised patients. Acta Radiol. 2015
Apr;56(4):447-53

Keywords

Lung, Infection, Fungal infection,