대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Pulmonary cryptococcosis in immunocompetent patient

Radiologic Findings

Chest radiography shows ground glass opacity below left hilum. Two nodules in LULF and RLLF show no interval changes. Chest CT shows 1.8 cm oval shape nonenhancing nodule in posterior segment of left upper lobe. This nodule shows focal intense FDG uptake (maxSUV=5.12) on PET-CT. Surgical resection was performed.

Brief Review

Pulmonary cryptococcosis is caused by fungal group of Cryptococcus species (m/c: C. neoformans). Once inhaled, the organism causes a localized granulomatous reaction and then spreads via the lymphatics to hilar and mediastinal lymph nodes. Disease process may arrest at this point, or may progress to disseminated disease. Pulmonary cryptococcosis is usually confined to the lung in immunocompetent patients, but may be severe and disseminated in immunocompromised hosts.
As pulmonary manifestation in immunocompetent patients, nodule or mass is the most common form. It is usually small, smoothly marginated, solitary or multiple(more likely bilateral), upper and middle lung predominance, and tends to be distributed peripherally. However, consolidation, cavitation, ground-glass opacity, lymphadenopathy, and pleural effusion can also be seen. The extent of pulmonary manifestation is also dependent on patients’ immune status.
The range of FDG uptake of cryptococcal nodule is wide, with maxSUV varying from 2.2 to 11.6, which cannot exclude malignancies according to maxSUV values only.

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 91, Case 923,

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. Khoury MB, Godwin JD, Ravin CE et al., Thoracic cryptococcosis: immunologic competence and radiologic appearance, American Journal of Roentgenology. 1984;142: 893-896.
2. Zinck SE, Leung AN, Frost M et al., Pulmonary cryptococcosis: CT and pathologic findings. J Comput Assist Tomogr 2002;26:330-334
3. Lindell RM, Hartman TE, Nadrous HF, Ryu JH, Pulmonary Cryptococcosis: CT Findings in Immunocompetent Patients, Radiology 2005; 236:326–331
4. Danial L. Fox, Nestor L. Müller, Pulmonary Cryptococcosis in Immunocompetent Patients: CT Findings in 12 Patients, American Journal of Roentgenology. 2005;185: 622-626.
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
6. Huang CJ, You DL, Lee PI et al., Characteristics of integrated 18F-FDG PET/CT in Pulmonary Cryptococcosis, Acta Radiol. 2009 May;50(4):374-8.

Keywords

Lung, Infection, Bacterial infection,