대한흉부영상의학회 Korean Society of Thoracic Radiology

대한흉부영상의학회 Weekly Case 메뉴

Close

대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
Advanced Search..

Close

Weekly Chest CasesArchive of Old Cases

Case No : 1013 Date 2017-03-27

  • Courtesy of Hyun Jung Yoon, Youkyung Lee / Hanyang University Guri Hospital
  • Age/Sex 65 / F
  • Chief Complaintincidental abnormality on CXR
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7
  • Figure 8
  • Figure 9

Diagnosis With Brief Discussion

Diagnosis
Pulmonary histoplasmosis
Radiologic Findings
On initial chest radiograph, a mass is seen in the right lower lobe. CT scan demonstrates a 37 mm lobulated mass showing mild enhancement with focal necrosis in the right lower lobe. Underlying emphysema is also seen. Our first radiologic diagnosis was lung cancer. The lesion nearly disappeared on follow-up chest radiograph and CT after one year.

Percutaneous C-Arm Cone-Beam CT-guided biopsy was performed. Pathologic finding revealed chronic granulomatous inflammation with small (1 to 5 micron) narrow base budding yeast cells. Periodic acid–Schiff and Grocott's methenamine silver staining results were positive, consistent with pulmonary histoplasmosis. After taking itraconazole for one year, the lesion almost disappeared.
Brief Review
Pulmonary histoplasmosis is caused by the organism Histoplasma capsulatum, which is an organism endemic to El Salvador but can be found widely in other parts of North, Central, and South America. It can show variable clinical and radiographic presentations depending on the state of infection and other host co-morbidities. Primary pulmonary infection results from the inhalation of airborne microconidia, and the vast majority of infections are self-limiting; in most cases, the infection is limited to the lungs, but since the onset of the AIDS epidemic, disseminated histoplasmosis has been reported with greater frequency.
A review of the literature revealed that there have been cases of histoplasmosis mimicking malignancy as was in our case. There are sporadic reports of patients with histoplasmosis who have been misdiagnosed as having head and neck cancer, primary lung cancer, or lymphoma. On CT scans as well as positron emission tomography, histoplasmosis can mimic malignant lesions.
References
1. Dall Bello AG1, Severo CB, Guazzelli LS, Oliveira FM, Hochhegger B, Severo LC. Histoplasmosis mimicking primary lung cancer or pulmonary metastases. J Bras Pneumol. 2013;39:63-68
2. Kauffman CA. Histoplasmosis: a clinical and laboratory update. Clin Microbiol Rev. 2007;20:115-132
3. Gurney JW, Conces DJ. Pulmonary histoplasmosis. Radiology 1996;199:297-306
Keywords
Histoplasmosis, Fungal infection, Lung,

No. of Applicants : 115

▶ Correct Answer : 9/115,  7.8%
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Chungbuk National University Hospital , Korea (South) CHANGHOON OH
  • - Chung buk national university hospital , Korea (South) hong gwon Byun
  • - Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Chungbuk national university , Korea (South) Yong Hun Kim
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Chungbuk National University Hospital , Korea (South) HYEONMI RYU
▶ Correct Answer as Differential Diagnosis : 18/115,  15.7%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - dayanand , India REENA GUPTA
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Kizawa Memorial Hospital , Japan Tomohiro Ando
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Korea University Guro Hospital , Korea (South) Bit Na Park
  • - Chungbuk National University Hospital , Korea (South) SOOJUNG LEE
  • - Seoul National University Hospital , Korea (South) SU YEON AHN
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - Busan National University Hospital , Korea (South) CHANGMU LEE
  • - GHICL , France MANUEL TOLEDANO
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • Top
  • Back

Each Case of This Site Supplied by the Members of KSTR.
Copyright of the Images is in the KSTR and Original Supplier.
Current Editor : Eui Jin Hwang, M.D., Ph.D Email : weeklychestcases@gmail.com

This website is optimized for IE 10 and above.