대한흉부영상의학회 Weekly Chest Cases

Case No : 842 Date 2013-12-16

Courtesy of Yoon Kyung Kim, Yon Mi Sung, Eun Young Kim / Gachon University Gil Medical Center
Age/Sex 27 / F
Chief Complaintleft back pain

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Diagnosis With Brief Discussion

Diagnosis: Pulmonary cryptococcosis in an immunocompetent host
Radiologic Findings: Initial chest radiograph shows mass-like consolidation with suspicious cavitation in left lower lung zone. CT images show dense consolidation with internal necrosis and cavitation in left lower lobe.
Pathologic finding of the percutaneous needle biopsy specimen reveled chronic inflammation with microorganisms, consistent with cryptococcosis. After the treatment with fluconazole, the consolidative lesion in left lower lobe showed much improvement.
Brief Review: Cryptococcus neoformans is an encapsulated yeast-like fungus found worldwide. Human infection is mainly through inhalation to the lung. The organism may cause isolated pulmonary infection or may progress to disseminated disease with CNS infection. Pulmonary cryptococcosis in the immunocompetent host is rare and may be asymptomatic.
The most common radiologic finding of pulmonary cryptococcosis is single or multiple pulmonary nodules. Segmental or lobar consolidation, ground glass opacities, miliary disease, cavitation, pleural effusions, and lymphadenopathies are also recognized features.
References: 1. Lindell RM, Hartman TE, Nadrous HF, et al. Pulmonary Cryptococcosis: CT Findings in Immunocompetent Patients. Radiology 2005;236:326
2. Fox DL, Muller NL. Pulmonary cryptococcosis in immunocompetent patients: CT findings in 12 patients. AJR Am J Roentgenol 2005;185:622-626
3. Song KD, Lee KS, Chung MP et al. Pulmonary Cryptococcosis: Imaging Findings in 23 Non-AIDS Patients. Korean J Radiol 2010;11:407-416
Please refer to: Case 181 Case 305 Case 346 Case 388 Case 446 Case 484 Case 512 Case 632 Case 770 Case 817 Case 831
Keywords: Lung, Infection, Fungal infection,

No. of Applicants : 60

▶ Correct Answer : 8/60, 13.3%

- kanto Rosai Hp , Japan Takana Yamakawa
- McGill University Health Center , Canada Alexandre Semionov
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- Kyoto University , Japan Akihiko Sakata
- Medicheck health care , Korea (South) Chae Lim
- Kizawa Memorial Hospital , Japan Yo Kaneko
- TCM HOSPITAL OF ZIGONG , China Cao Cunyou
- Kyungpook National University Hospital , Korea (South) Jaekwang Lim

▶ Correct Answer as Differential Diagnosis : 17/60, 28.3%

- Oita University, Faculty of Medicine , Japan Fumito Okada
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Avrasya Hospital , Turkey Murat Ulusoy
- Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
- University of British Columbia , Canada Amr Ajlan
- Onomichi municipal hospital , Japan Hirofumi Mifune
- IRSA La Rochelle , France Denis Chabassiere
- Niigata University , Japan Atsushi Uehara
- Tokyo Metropolitan Police Hospital , Japan Akifumi Hagiwara
- DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- NASA SCANS , India RAKESH BHATIA
- chp st martin , France Mariotte benoit
- Shiga University of Medical Science , Japan Akitoshi Inoue
- Asan medical center , Korea (South) Cherry Kim
- CBH Dpt of Imaging Clinica Mater Dei BARI , Italy Carlo Florio
- All India Institute of medical sciences , India Justin Moses

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 842 Date 2013-12-16

Discussion

No. of Applicants : 60