대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Pulmonary cryptococcosis

Radiologic Findings

Initial chest radiograph shows multifocal patchy dense air space consolidations in right lung and left middle and lower lung zones. CT images show multifocal dense consolidations in both emphysematous lungs showing air bronchograms, and there were no significant lymph node enlargements. Cryptococcosis was proven by core needle biopsy(Fig), and for additional information patient's immune status was within normal limits.
After 5 months of anti-fungal treatment with fluconazol, multifocal consolidative lesions in both lungs showed much improvement(Fig).

CT after angifungal treatment

Lung biopsy from the posterior segment of left lower lobe;PAS(+), D-PAS(+), GMS (+)

Brief Review

Cryptococcus neoformans is an encapsulated yeastlike fungus found worldwide. Human infection is mainly through inhalation to the lung, however systemic dissemination with CNS system infection is the most common form of cryptococcosis, and lung is the second most common site of infection. Cryptococcal infections are relatively rare and asymptomatic in immunocompetent hosts, mostly occuring in immunocompromised hosts.
Since pulmonary cryptococcosis occurring in immunocompetent hosts is a relatively rare manifestation, typical radiographic findings are not firmly established yet. However, several previous studies state similar findings that can be considered as relatively established findings of pulmonary cryptococcosis in immunocompetent hosts. The most common radiographic feature was well or ill defined pulmonary nodules or masses. Other findings included areas of segmental or lobar consolidations, ground glass opacities, and miliary disease, cavitation, pleural effusions, lymphadenopathies were also recognized features. Generally, there were tendencies of immunocompromised hosts showing higher incidence of pulmonary parenchymal abnormalities, and in contrary, immunocompetent hosts showed higher incidence of pulmonary nodules and masses.

References

1. Danial L. Fox, Nestor L. Muller. Pulmonary Cryptococcosis in Immunocompetent Patients: CT Findings in 12 Patients. AJR 2005; 185:622-626.
2. Rebecca M. Lindell, Thomas E. Hartman, Hassan F. Nadrous, Jay H. Ryu. Pulmonary Cryptococcosis: CT Findings in Immunocompetent Patients. Radiology 2005; 236:326-331.
3. Ming-Szu Hung, Ying-Huang Tsai, Cheng-Hui Lee, Cheng-Ta Yang. Pulmonary cryptococcosis: Clinical, radiographical and serological markers of dissemination. Respirology (2008) 13, 247-251.

Please refer to

Case 770 Case 754 Case 671 Case 512 Case 446 Case 388 Case 382

Keywords

Lung, Infection, Fungal infection,