대한흉부영상의학회 Weekly Chest Cases

Case No : 632 Date 2009-12-07

Courtesy of Jin Hur, Hye-Jeong Lee, Hua Sun Kim, Young Jin Kim, Ji Eun Nam, Byoung Wook Choi, Kyo Ok Choe / Severance Hospital, Yonsei University College of Medicine
Age/Sex 71 / M
Chief ComplaintCough and sputum for 15 days

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Initial chest PA.

Diagnosis With Brief Discussion

Diagnosis: Cryptococcal infection
Radiologic Findings: Initial chest radiography shows patchy consolidation in the left lower lung field. Follow up chest CT after 2 weeks shows nodular consolidation in the left lower lobe and small amount of effusion. There was no evidence of enlarged lymphadenopathy in the hilum and mediastinum.
Brief Review: Cryptococcus neoformans is thin-walled, non-mycelial, budding encapsulated yeast. Cryptococcal infections most commonly occur in immunocompromised hosts, such as those with acquired immunodeficiency syndrome, transplant-related immunosuppression, or hematologic malignancies. Pulmonary cryptococcosis in the immunocompetent host is rare and may be asymptomatic. The most common radiographic manifestations of pulmonary cryptococcosis consist of single or multiple pulmonary nodules. Cavitation occurs in 10-15% of cases. Hilar and mediastinal adenopathy may accompany any of these patterns, as may pleural effusion. Segmental or lobar consolidation and miliary pattern are seen less commonly. Cryptococcal pneumonia in AIDS patients shows somewhat different features from those described in non immunocompromised patients in that nodular masses are uncommon and lymphadenopathy is a frequent findings.
Diagnosis of pulmonary cryptococcosis can be established by transbronchial or transthoracic biopsy based on identification of the characteristic yeast-like organism with capsule in tissue with India ink, silver or mucicarmine stain
References: 1. Lindell RM, Hartman TE, Nadrous HF, Ryu JH. Pulmonary cryptococcosis: CT findings in immunocompetent patients. Radiology 2005;236:326-331.
2. Fox DL, Muller NL. Pulmonary cryptococcosis in immunocompetent patients: CT findings in 12 patients. AJR 2005;185:622-626.
3. Miller WT Jr, Edelman JM, Miller WT. Cryptococcal pulmonary infection in patients with AIDS: radiographic appearance. Radiology 1990;175:725-728.
Keywords: Lung, Infection, Fungal infection,

No. of Applicants : 73

▶ Correct Answer : 7/73, 9.6%

- seoul national university hospital , Korea (South) Ijin Joo
- Uzunkopru Devlet Hastanesi , Turkey Armagan Sarac
- clinique de rochefort , France viviane pages
- Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
- Homs National Hospital , Syria Rami Abou Zalaf
- McGill University Health Center , Canada Alexandre Semionov
- EKH-Berlin , Germany Michael Weber

▶ Correct Answer as Differential Diagnosis : 11/73, 15.1%

- Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
- PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- partner, aditya imaging centre , India vivek patel
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OKUBO
- IRSA La Rochelle France , France Denis Chabassiere
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- NASA SCANS , India RAKESH BHATIA
- Hopital du SacrCoeur , Canada Abraham Bohadana

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 632 Date 2009-12-07

Discussion

No. of Applicants : 73