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Weekly Chest CasesArchive of Old Cases

Case No : 1320 Date 2023-02-06

  • Courtesy of Yoon Joo Shin, Su Yeon Ahn, Jeong Geun Yi / Konkuk University Medical Center
  • Age/Sex 71 / F
  • Chief ComplaintIncidental lung nodules
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Pulomonary cryptococcosis
Radiologic Findings
Fig 1. Chest PA shows multifocal increased nodular opacities in both lower lung fields.
Fig 2-5. CT scans reveals multifocal ill-defined nodules and nodular consolidations with surrounding halo (ground-glass opacities (GGO)).
The patient had CT-guided PTNB and the pathology report revealed cryptococcal infection.
Brief Review
Cryptococcus neoformans is a widespread yeast-like fungus found globally, particularly in soil contaminated by pigeon droppings and decaying wood. Inhaling its particles can cause a lung infection, which can then spread to the central nervous system. The infection mainly affects immunocompromised patients, particularly those with a compromised cell-mediated immune response. Immunocompetent individuals may experience mild or no symptoms with isolated lung involvement, but more severe symptoms and imaging findings can occur.
Pulmonary infection from Cryptococcus neoformans can present in various forms, such as lung nodules or mass-like appearances. The most common CT findings result in Immunocompetent patients is multiple, small (less than 10mm), well-defined, and smooth-margined pulmonary nodules located in the middle and upper lungs, affecting less than 10% of the lung parenchyma. Masses, areas of consolidation, lymphadenopathy, pleural effusions, and cavitation are less common. AIDS patients tend to experience a more widespread thoracic disease with interstitial lung pattern and enlarged lymph nodes. Although treatment with antifungal therapy can improve patients' clinical conditions, radiological improvement is slow and lung lesions may persist for a long time, even after treatment.
References
1. Song KD, Lee KS, Chung MP, et al. Pulmonary cryptococcosis: imaging findings in 23 non-AIDS patients. Korean J Radiol. 2010;11(4):407-416. doi:10.3348/kjr.2010.11.4.407
2. Suwatanapongched T, Sangsatra W, Boonsarngsuk V, et al. Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment. Diagn Interv Radiol. 2013;19(6):438-446. doi:10.5152/dir.2013.13049
Keywords

No. of Applicants : 96

▶ Correct Answer : 31/96,  32.3%
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Other , Korea (South) SEONGSU KANG
  • - zhongshai hospital, fudan university , China FENG HUA
  • - , China FANG YING GEN
  • - , Japan FUMINORI MIYOSHI
  • - Kaneda hospital , Japan HIROFUMI MIFUNE
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - , Korea (South) MINJI KIM
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - Ajou University Hospital , Korea (South) HYUNSEUNG LEE
  • - , Japan YUKIKO USUI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Hukuda memorial hospital , Japan SHINTARO KANO
  • - , Japan KENTARO KOTANI
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Kyoto University , Japan SHO KOYASU
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - , Japan NOBUYUKI OTANI
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - Kyoto university , Japan AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 16/96,  16.7%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - Other , Korea (South) CHAEHUN LIM
  • - , Qatar NABIL SHERIF MAHMOOD
  • - Other , Korea (South) SEONG WON JANG
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
  • - Chonnam National University Hospital , Korea (South) SOMIN LEE
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Sotiria Hospital, Athens , Greece VASILIOS TZILAS
  • - , Japan YUKI HAYASHI
▶ Semi-Correct Answer : 3/96,  3.1%
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Ajou University Hospital , Korea (South) JAYOUNG MOON
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
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