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Weekly Chest CasesArchive of Old Cases

Case No : 117 Date 2000-01-22

  • Courtesy of Koun-Sik Song, M.D. / Asan Medical Center, Seoul, Korea
  • Age/Sex 28 / F
  • Chief ComplaintFever and chill for three days. Kidney transplantation due to end-stage renal disease two months previously.
  • Figure 1
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  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Nocardiosis
Radiologic Findings
Chest radiograph shows multiple nodular opacities in the right lung with a surrounding consolidation area in the right lower lung zone.
Contrast-enhanced chest CT scans show multiple, variable-sized, peripheral lung nodules in the right middle and lower lobes.
Peripheral rim enhancement with a central low attenuation area was identified within the nodules or subpleural consolidation areas in the right lung on a mediastinal window setting.
Subpleural nodule and peripleural abscess with extension to adjacent chest wall suggests transfascial extension.
Gram-positive, filamentous branching rods of nocardia were identified in aspirates (below).
Brief Review
Nocardiosis is localized or disseminated infection caused by a soil-borne aerobic bacterium, Nocardia asteroides, usually introduced through the respiratory tract.
Common predisposing factors for nocardial infection include corticosteroid therapy, neoplasm, chemotherapy for neoplasm, and immunosuppressants for organ transplantation, or alveolar proteinosis.
Chest radiographic findings of pulmonary nocardiosis include localized consolidation with or without cavitation, nodules or cavitary masses representing necrotizing pneumonia, or pleural effusion.
Typical CT findings of pulmonary nocardiosis are consolidation with internal low attenuation areas with or without cavities, multiple parenchymal or subpleural nodules, pleural effusion, empyema, and chest wall extension.
Radiographic differential diagnosis includes pleuropulmonary actinomycosis, metastasis or septic infarcts in the patient with known malignancy or in the immunocompromised host.
References
1. Fraser RS, Pare JAP. Synopsis of diseases of the chest. 2nd ed. Philadelphia : Sounders. 1994; 354

2. Yoon HK, Im JG, Ahn JM, Han MC. Pulmonary nocardiosis: CT findings. J Comput Assist Tomogr 1995;19(1):52-55
Keywords
Lung, Infection, Bacterial infection,

No. of Applicants : 49

▶ Correct Answer : 37/49,  75.5%
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  • - Eulji college hospital Yookyung Kim
  • - Pusan National University Hospital Kun-Il Kim
  • - Samsung Medical Center Kyung Soo Lee
  • - Samsung Medical Center Eung-Yeop Kim
  • - Seoul National University Hospital Jung-Gi Im
  • - Seoul National University Hospital Seong Ho Park
  • - Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
  • - Yeungnam Univ. Hospital Jaekyo Lee
▶ Semi-Correct Answer : 4/49,  8.2%
  • - Hospital General Universitario de Alicante Spain Juan Arenas
  • - Hospital La Fe., Valencia, Spain Daniel Perez Enguix
  • - NANAVATI HOSPITAL BOMBAY BHARAT GALA
  • - Hospital de Leon. Leon. Spain Inmaculada Herraez Ortega
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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