Weekly Chest CasesArchive of Old Cases

Case No : 770 Date 2012-07-31

  • Courtesy of Inyoung Song, Jeong Geun Yi / Konkuk University Medical Center
  • Age/Sex 62 / M
  • Chief ComplaintCough and sputum for 1 week
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Figure 1. Initial chest PA

Diagnosis With Brief Discussion

Diagnosis
Cryptococcosis (The diagnosis was made by transthoracic needle biopsy)
Radiologic Findings
Initial chest radiography shows patch consolidation in the right middle lung zone. Follow up chest CT after 2 weeks shows mass-like consolidation with ill-defined border in the superior segment of right lower lobe. There was no evidence of enlarged lymphadenopathy in the hilum and mediastinum.
Brief Review
Humans likely become infected with C. neoformans by inhaling the basidiospore form of the fungus or small poorly encapsulated yeasts. Basidiospores are smaller than the yeast forms obtained from clinical samples and have much smaller polysaccharide capsules, facilitating deposition in the alveoli and terminal bronchioles after inhalation. Following inhalation, C. neoformans likely causes a focal pneumonitis that may or may not be symptomatic. The immune status is the most important determinant of the subsequent course of the infection (eg, whether the pneumonitis resolves or progresses to symptomatic dissemination).
Radiographic findings
References
Song KD, Lee KS, Chung MP, Kwon OJ, Kim TS, Yi CA, Chung MJ. Pulmonary cryptococcosis: Imaging findings in 23 non-AIDS patients. Korean J Radiol 2010; 11:407-416
Imaging of pulmonary infections. Muller NL, Franquet T, Lee KS. Silva CI. Lippincotte Williams & Wilikins 2007
Keywords
lung, infection, fungal,

No. of Applicants : 80

▶ Correct Answer : 7/80,  8.8%
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae-Wook Yeh
  • - Kyung Hee University Medical center , Korea (South) Myung You
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - radiologist, aditya imaging centre , India vivek patel
  • - Radnet Teleradiology Istanbul , Turkey Armagan Sarac
  • - Medicheck health care , Korea (South) Chae Lim
▶ Correct Answer as Differential Diagnosis : 20/80,  25.0%
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Goa Medical College , India Paresh Desai
  • - UWO , Canada S Lee
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - China Medical University , Chia-Yi Christian Hospital ,Taiwan, R.O.C. , Taiwan Jun Jun Yeh
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - XiangYa hospital , China Xia Yu
  • - Chungnam national university , Korea (South) Seun Yun
  • - Himeji St.Mary Hospital , Japan Yuichiro Kanie
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - National Taiwan University Hospital , Taiwan Li-Ta Keng
  • - Private sector , Greece Vasilios Tzilas
  • - All India Institute of medical sciences , India Justin Moses
  • - Korea university anam hospital , Korea (South) Sung-Hye You
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
▶ Semi-Correct Answer : 11/80,  13.8%
  • - Dong-A University Hospital , Korea (South) Ji-yeon Han
  • - Kosin University Gospel Hospital , Korea (South) Hee Kang
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - CHRU lille , France manuel toledano
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Korea university , Korea (South) SUMIN HA
  • - Fukuyama city hospital , Japan Ryotaro Kishi
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Okayama university , Japan Mayu Uka
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