Archive of Old Cases
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Case No : 1153 Date 2019-12-05
- Courtesy of Young Hun Jeon, Yeong Tae Park, Jin Young Yoo / Chungbuk National University Hospital
- Age/Sex 41 / M
- Chief ComplaintIncidental finding on routine APCT, MALT lymphoma patient on chemotheraphy
Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Pulmonary Cryptococcosis
- Radiologic Findings
- Fig 1. Chest PA shows a few nodules and consolidations in the right lower lung field.
Fig 2-6. Contrast enhanced CT scan demonstrated multiple nodules and masses with enhancement and surrounding ground glass opacities in the right lower lobe.
Fig 7. Mass shows focal intense FDG uptake (SUVmax =18.8) on PET-CT.
US guided needle biopsy specimen of the patient shows pulmonary cryptococoosis.
- Brief Review
- Cryptococcus neoformans is a ubiquitous encapsulated yeast-like fungus that is found worldwide; particularly in soils that are contaminated with pigeon excreta and decayed wood. Inhalation of cryptococcal particles into the lungs is a route of pulmonary infection, and subsequent hematogenous dissemination may cause central nervous system 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 most common CT findings in immunocompetent patients with pulmonary cryptococcosis were pulmonary nodules. The nodules were most often multiple, smaller than 10 mm in diameter, and well defined with smooth margins. Nodules most commonly involved less than 10% of the parenchyma and were distributed in the middle and upper lungs. Multiple nodules were most commonly bilateral. Masses, areas of consolidation, cases of lymphadenopathy, pleural effusions, and areas of cavitation occurred infrequently. Pulmonary cryptococcosis in AIDS patients tends to manifest itself as a disseminated thoracic disease with an interstitial lung pattern and lymph node enlargement as seen on imaging studies. The lesions may show high FDG uptake and may thus simulate a malignant condition at PET. Although clinical improvement can be achieved in all patients, radiological improvement is slow, even after antifungal therapy. Lastly, lung lesions may persist for a long time, showing a divergence from the clinical response.
- Please refer to Case 181, Case 231, Case 247, Case 282, Case 305, Case 346, Case 368, Case 388, Case 446, Case 484, Case 512, Case 603, Case 632, Case 671, Case 754, Case 770, Case 817, Case 831, Case 842, Case 862, Case 891, Case 923, Case 945, Case 964, Case 987, Case 1046, Case 1150,
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KSTR Imaging Conference 2001 Spring Case 16
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Thoracic Imaging 2003- Korean & Japanese Film Interpretation - Case 5 ,
KSTR Imaging conference 2009 Summer Case 16,
- References
- 1. Lindell RM, Hartman TE, Nadrous HF, et al. Pulmonary cryptococcosis: CT findings in immunocompetent patients. Radiology. 2005 Jul;236(1):326-31.
2. Song KD, Lee KS, Chung MP, et al. Pulmonary Cryptococcosis: Imaging Findings in 23 Non-AIDS Patients. Korean J Radiol. 2010 Jul-Aug; 11(4): 407–416.
- Keywords
- lung, fungal infection, cryptococcosis,
No. of Applicants : 55
- ▶ Correct Answer : 23/55, 41.8%
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- - the first affiliatited hospital of nanjing medical univercity , China HAI XU
- - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
- - Mayo Clinic , United States AKITOSHI INOUE
- - Kizawa Memorial Hospital , Japan Shoji Okuda
- - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- - Jiangsu province hospital , China WANGJIAN ZHA
- - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
- - Oita University, Faculty of Medicine , Japan Fumito Okada
- - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
- - Chonbuk National University Hospital , Korea (South) SOL KI KIM
- - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
- - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
- - Gifu University Hospital , Japan Yo Kaneko
- - Toranomon Hospital , Japan KAORU SUMIDA
- - Hamamatsu University Hospital , Japan YUKI HAYASHI
- - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
- - Other , Korea (South) SEONGSU KANG
- - TB centre kasaragod. , India rikhy krishnan
- ▶ Correct Answer as Differential Diagnosis : 13/55, 23.6%
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- - , Japan YUMI MAEHARA
- - Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG
- - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
- - , Korea (South) JIN YOUNG LEE
- - , Korea (South) JANG SEONG WON
- - , Korea (South) CHOHEE KIM
- - Chonbuk National University Hospital , Korea (South) MINJEE KIM
- - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
- - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
- - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- - , Japan KAZUMA TERAUCHI
- ▶ Semi-Correct Answer : 7/55, 12.7%
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- - Seoul National University Hospital , Korea (South) JI HEE KANG
- - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
- - The University of Tokyo Hospital , Japan RYO KUROKAWA
- - Seoul National University Hospital , Korea (South) Ju Gang Nam
- - chp st martin , France BENOIT HENR MARIOTTE
- - Asan Medical Center , Korea (South) EUNJI CHOI
- - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
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