대한흉부영상의학회 Weekly Chest Cases

Case No : 346 Date 2004-06-12

Courtesy of Myung Hee Chung, M.D. / Holy Family Hospital, Catholic Universit, Kyoungkido, Korea
Age/Sex 19 / M
Chief ComplaintCoughing for 2 weks, blood-rtinged sputum, elevated IgE(1039 IU/ml) P/H: none except for sinusitis

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Diagnosis With Brief Discussion

Diagnosis: Cryptococcal infection in immunocompetent patient
Radiologic Findings: Chest radiographs showed multiple cavitating nodules and consolidations in the posterior aspect of both central lung fields. Chest CT showed ill-defined cavitating nodules with surrounding ground glass opacities. The lesion was moderately enhanced. No lymphadenopathy or pleural effusion noted. Pathologic diagnosis, obtained by wedge resection was granulomatous inflammation with abscess formation. PAS and silver staining revealed cryptococcus (small and black, ring-shaped organisms).
Brief Review: Pulmonary infection with C. neoformans can be aymptomatic and subclinical, mild and self-limited or severe and progressive. The noncompromed hosts tended to have a radiographic pattern of a peripheral nodue or nodules. Segmental pneumonias, miliary nodules, cavitation, lymphadenopathy, and pleural effusions are less common in immunocompetent patients. The recent report regarding to HR CT manifestations described multiple nodules including surrounding centrilobular nodules without “tree-in-bud” appearance. Diagnosis was confirmed by cytologic observation and culture of the organism. A case of multiple cavities on chest film had a high titer serum cryptococcal antigen. Biopsy showed expansion of the alveolar spaces by foamy macrophages, numerous cryptococcal yeast forms, and proteinaceous eosinophilic fluid collection, and a minimal interstitial nomonuclear inflammatory response devoid of granulomas.
References: 1. Murayama S et al. Pulmonary cryptococcosis in immunocompetent patients HRCT characteristics. Clinical Imaging 2004;28:191-195

2. Zinck SZ et al. Pulmonary cryptococcosis: CT and Pathologic findings. JCAT 2002;26(3):330-334

3. Nunez M et al. Pulmonary cryptococcosis in the immunocompetent host. Chest 2000;228(2):527-534

4. Khoury MB et al. Thoracic cryptococcosis. AJR 1984;141:883-896

5. Maeda J et al. A case of multiple cavities on chest film with high titer serum cryptococcal antigen. Nihon Kyobu Shikkan Gakkai Zasshi. 1989;27(11):1330-1334
Keywords: Lung, Infection, Fungal infection,

No. of Applicants : 36

▶ Correct Answer : 3/36, 8.3%

- CIM Saint Dizier, France JC Leclerc
- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- National Taiwan University Hospital, Taiwan Tan Che Kim

▶ Semi-Correct Answer : 23/36, 63.9%

- Air force education & training command Hospital, Korea Hyukwon Chang
- Annecy Hospital, France Gilles Genin
- Centre d'imagerie Jacques Callot, Nancy, France Lionel Cannard
- CHU Nancy-Brabois, France Denis Regent
- Clinic 1, Moscow, Russia Lepikhina Dasha
- Clinica Prever, Brazil Arismar Leon Pereira
- Dong-A University Hospital, Korea Ki-Nam Lee
- Escola Paulista de Medicina, Brazil Jose Luiz Masson de Almeida Prado
- Eulji hospital, Korea Jeong Joo Woo
- Geneva University Hospitals, Switzerland A.B. Younossian
- GeojeBaek Hospital, Gyungnam, Korea James Lim
- Gwangmyoung Sung-Ae Hospital, Korea Jiyong Rhee
- Hangang SacredHeart Hospital, Korea Eil Seong Lee
- Hanyang University Hospital, Seoul, Korea Mi-Jeong Jang
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Hospital de Basurto, Bilbao Inigo Lecumberri
- Incheon Sarang Hospital, Korea Jung Hee Kim
- Jecheon Hyundai Hospital, Korea Seung Hun Ryu
- Mallinckrodt Institute of Radiology, USA Jin Mo Goo
- Pohang hospital, Korea Jae hyoung Park
- Royal Melbourne Hospital, Melbourne, Australia Stefan Heinze
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- UNIFESP-EPM and Center of Diagnostic Brazil, Brazil Isabela Silva

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 346 Date 2004-06-12

Discussion

No. of Applicants : 36