대한흉부영상의학회 Weekly Chest Cases

Case No : 754 Date 2012-04-10

Courtesy of Soo-Youn Ham / Korea University Anam Hospital
Age/Sex 57 / M
Chief ComplaintPatient with colon cancer and liver metastasis (5 months ago)

Figure 1
Figure 2
Figure 3

Figure 1. 4 months ago

Diagnosis With Brief Discussion

Diagnosis: Pulmonary cryptococcosis
Radiologic Findings: Well defined discrete pulmonary nodules, RLL with interval growth, compared with CT scan (4 months ago) were shown.
PET-CT revealed mild hypermetabolism
Brief Review: Cryptococcosis occurs predominantly in immunocompromised patients but can also be found in normal host. The pattern of pulmonary cryptococcal infection depends on the host immune status. In the immunocompromised patients, it can cause symptomatic pulmonary infections and disseminated to the central nervous system. In the immunocompetent host, infections are localized to the lungs and usually asymptomatic.
The radiology patterns of pulmonary cryptococcosis are nodules, masses and consolidations with GGO. Sometimes, linear opacities with septal thickenings are the dominant features. Small numbers of patient manifest as solitary nodule with enhancement, mimics malignant nodule. About 1/3 of patients are asymptomatic and some have variable clinical symptoms of cough and low- grade fever. The incidence of cavitary nodule is relatively higher in the young adults and immunocompromised hosts. In the above patients, he was no evidence of immunocompromised state.
References: 1) Lindell RM, Hartman TE, Nadrous HF, Ryu JH. Pulmonary cryptococcosis: CT findings in immunocompetent patients. Radiol 2005;236-326-331
2) Chang WC, Tzao C, Hsu HH, eta al. Pulmonary cryptococcosis: comparison of clinical radiographic characteristics in immunocompetent and immunmocompromised patients. Chest 2006;129:333-340
3) Imaging of pulmonary infections. Muller NL, Franquet T, Lee KS. Silva CI. Lippincotte Williams & Wilikins 2007
Keywords: lung, infection, fungal,

No. of Applicants : 101

▶ Correct Answer : 10/101, 9.9%

- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Onomichi municipal hospital , Japan Ryotaro Kishi
- Oita University, Faculty of Medicine , Japan Fumito Okada
- China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
- royal melbourne hospital , Australia kimchi kings
- Asan Medical Center , Korea (South) Ji Eun Kim
- Korea university , Korea (South) Kun Woo Kang
- Himeji St.Mary , Japan Yuichiro Kanie
- Kizawa Memorial Hospital , Japan Yo Kaneko
- Private sector , Greece Vasilios Tzilas

▶ Correct Answer as Differential Diagnosis : 12/101, 11.9%

- radiologist, aditya imaging centre , India vivek patel
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Kurashiki Seijin-byo Center , Japan Akihiro Tada
- Onomichi municipal hospital , Japan Hirofumi Mifune
- fmmc , India subas kandimalla
- Chungbuk National University Hospital , Korea (South) Su Jeong Hyun
- Kohka Public Hospital , Japan Akitoshi Inoue
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- XiangYa hospital , China Xia Yu
- Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
- All India Institute of medical sciences , India Justin Moses

▶ Semi-Correct Answer : 9/101, 8.9%

- University of British Columbia , Canada Amr Ajlan
- Heart Center Pontica , Bulgaria VLADISLAV RUSINOV
- UWO , Canada S Lee
- McGill University Health Center , Canada Alexandre Semionov
- IRSA Rochefort , France Viviane Pages
- Goa Medical College , India Paresh Desai
- SMC , Korea (South) Yi Kyung Kim
- Chungbuk univertisy hospital , Korea (South) Soohyun Lee
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 754 Date 2012-04-10

Discussion

No. of Applicants : 101