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Weekly Chest CasesArchive of Old Cases

Case No : 671 Date 2010-09-05

  • Courtesy of Byung Hak Rho / Dongsan medical center, Keimyung university
  • Age/Sex 75 / F
  • Chief ComplaintDiabetes mellitus for 30 years
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Cryptococcosis
Radiologic Findings
Chest PA shows bilateral nodular opacities and patchy consolidation in both lung fields.
Cross-sectional high-resolution CT images show diffusely scattered multiple nodules in both lung zones. Note multiple nodules in both interlobar fissure and subpleural areas.
CT guided lung biopsy specimen of the patient shows multiple aggregates of tiny cyst like structure with clear space in the granulomatous lesion of the lung parenchyma. Mucicarmine stain reveals positive on the cystic surfaces. GMS stain also reveals aggregate of fungal cysts.

Mucicarmine stain

GMS stain

Brief Review
Cryptococcus neoformans is a ubiquitous encapsulated yeast-like fungus found worldwide, particularly in soil contaminated by pigeon droppings.
Inhalation of cryptococcal particles into the lungs is a route of pulmonary infection, and subsequent hematogenous dissemination may cause central nervous infection.
Cryptococcal infections are mostly common in immunocompromized patients such as those with AIDS, who underwent organ transplantation, or who have a hematologic malignancy. These infections are relatively rare in immunocompetent patients.
The radiologic manifestations of pulmonary cryptococcosis are thought to be affected by the patient's level of immunosuppression.
Pulmonary cryptococcosis in AIDS patients tends to manifest itself as a disseminated thoracic disease with an interstitial lung pattern and lymph node enlargements: whereas the infection in immunocompetent hosts shows single or multiple nodular lesions or mass-like consolidation.
The most common manifestation of pulmonary cryptococcosis on CT was pulmonary nodules. Nodules were typically 5-20 mm in diameter, smoothly marginated, either solitary or multiple in number, and associated with other parenchymal findings such as masses and consolidation. Cavitation in nodules and masses has been previously described as a radiographic feature particularly in immunosuppressed patients. Ground-glass opacities adjacent to or surrounding nodules in an appearance consistent with the CT halo sign were present in 40% of patients presenting with a nodular pattern of disease.
Pulmonary cryptococcosis is an indolent lung disease in non-AIDS patients that is slowly progressive in nature, even without adequate treatment.

References
1. Song KD, Lee KS, Chung MP, Kwon OJ, Kim TS, Yi CA, Chung MJ. Pulmonary cryptococcosis: Imaging findings in 23 non-AIDS patients. Korean J Radiol 2010; 11:407-416
Keywords
Lung, Infection, Fungal infection,

No. of Applicants : 100

▶ Correct Answer : 6/100,  6.0%
  • - KMC,Manipal , India satish maddukuri
  • - Goa Medical College , India Paresh Desai
  • - Shree Diagnostics , India amol jagdale
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Uzunkopru Devlet Hastanesi , Turkey Armagan Sarac
▶ Correct Answer as Differential Diagnosis : 26/100,  26.0%
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - NTUH , Taiwan Kuei-pin Chung
  • - Chonnam National University Hwasoon Hospiral , Korea (South) You Ri Choi
  • - University of British Columbia , Canada Amr Ajlan
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - All India Institute of medical sciences , India Justin Moses
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Mackay Memorial Hospital , Taiwan Sheng-Yeh Shen
  • - MANSORA CHEST HOSPITAL , Egypt AHMED FAYED
  • - royal melbourne hospital , Australia kimchi kings
  • - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - IRSA , France jean-luc BIGOT
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
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