대한흉부영상의학회 Weekly Chest Cases

Case No : 1150 Date 2019-11-13

Courtesy of Juyeon Lee, Woocheol Kwon / Wonju Severance Christian Hospital
Age/Sex 50 / M
Chief Complaintcough for 1week, alcoholic liver cirrhosis

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Diagnosis With Brief Discussion

Diagnosis: Pulmonary cryptococcosis
Radiologic Findings: Chest radiograph shows consolidation in right upper, lower lung zone and small nodule in left lower lung zone.
Contrast-enhanced chest CT images demonstrate peripheral consolidation with internal low density in right upper and middle lobe. Several irregular nodules or cavities are noted in both lungs. There are multiple enhancing lymph nodes in mediastinum and bilateral pleural effusion.

The patient underwent CT-guided transthoracic core-needle biopsy. Pathologic specimen revealed chronic granulomatous inflammation with numerous fungal yeasts, which were consistent with cryptococcosis.
Brief Review: Pulmonary cryptococcosis is caused by fungal group of Cryptococcus species (m/c: C. neoformans) which are ubiquitous encapsulated yeasts found worldwide. The infection usually affects immunocompromised patients, particularly those with an impaired cell-mediated immune response. Most immunocompetent individuals have mild or no clinical symptoms with isolated pulmonary involvement, otherwise more aggressive clinical and radiographic findings in immunocompetent patients.
Pulmonary cryptococcal infection has a variety of manifestations from lung nodules to mass-like appearance. The most common radiographic manifestations of pulmonary cryptococcosis consist of single or multiple pulmonary nodules, segmental or lobar consolidation or a reticulonodular pattern of opacities. Associated features include cavitation, lymphadenopathy and pleural effusion.
Please refer to: KSTR Imaging Conference 2001 Spring Case 6 ,
Thoracic Imaging 2003- Korean & Japanese Film Interpretation - Case 5 ,
KSTR Imaging conference 2009 Summer Case 16,
References: 1. SUWATANAPONGCHED, Thitiporn, et al. Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment. Diagnostic and Interventional Radiology, 2013, 19.6: 438.
2. THAMBIDURAI, Lasya, et al. Cryptococcal pneumonia: the great mimicker. BJR| case reports, 2017, 20150358.
Keywords: lung, fungal infection, cryptococcosis,

No. of Applicants : 55

▶ Correct Answer : 7/55, 12.7%

- Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
- Mayo Clinic , United States AKITOSHI INOUE
- Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- University of Tsukuba Hospital , Japan SODAI HOSHIAI
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG

▶ Correct Answer as Differential Diagnosis : 5/55, 9.1%

- Chonnam National University Hwasun Hospital , Korea (South) INWOO CHOI
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- Toranomon Hospital , Japan KAORU SUMIDA

▶ Semi-Correct Answer : 6/55, 10.9%

- McGill University Health Center , Canada Alexandre Semionov
- University of Michigan , United States GABIN YUN
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- , Korea (South) JANG SEONG WON
- National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
- Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1150 Date 2019-11-13

Discussion

No. of Applicants : 55