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Weekly Chest CasesArchive of Old Cases

Case No : 1199 Date 2020-10-18

  • Courtesy of Sung Ho Hwang, Yu-Whan Oh / Korea University Anam Hospital, Seoul
  • Age/Sex 49 / M
  • Chief Complaintdyspnea and chest pain for 3 weeks
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Cryptococcal pneumonia
Radiologic Findings
Figure 1. The posteroanterior chest radiograph shows multiple nodular opacities in bilateral lung fields. Large cavitary lesions are seen in left middle lung field.
Figure 2-5. Transverse images of chest CT show multiple variable nodules with or without adjacent ground-glass opacities. Left lung large cavities have irregular thick walls or abnormal fluid accumulation within cavities.

Figure 6. The following bronchoscopy shows multiple nodular polypoid mucosal lesions (arrows) in trachea and main bronchi.

Cryptococcal pneumonia confirmed with lung biopsy in this patient.

Figure 6. bronchoscopic finding

Brief Review
Cryptococcosis is a budding encapsulated yeast. It is found worldwide in association with birds, including pigeons. Cryptococcus neoformans (C. neoformans) is the most recognized species, and typically infects immunocompromised patients. Patients infected with C. neoformans may be asymptomatic or may have sign of pneumonia.
Chest radiographs commonly show solitary or multiple pulmonary nodules or masses measuring 5 to 40 mm in diameter. Nodules may cavitate. Miliary nodules may be seen in hematogenous dissemination. Immunocompetent patients also commonly show single or multiple nodules but rarely have consolidation, cavitation, lymphadenopathy, or pleural effusion. The most common CT finding is also single or multiple pulmonary nodules with varied margins in both immunocompromised and immunocompetent patients.
Please refer to
Case 247, Case 305, Case 346, Case 484, Case 632,
References
1. Murayama, S Sakai, H Soeda, et al.: Pulmonary cryptococcosis in immunocompetent patients: HRCT characteristics. Clin Imaging. 28:191-195 2004
2. RM Lindell, TE Hartman, HF Nadrous, et al.: Pulmonary cryptococcosis: CT findings in immunocompetent patients. Radiology. 236:326-331 2005
Keywords
lung, fungal infection, Cryptococcal pneumonia,

No. of Applicants : 66

▶ Correct Answer : 2/66,  3.0%
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Chonbuk National University Hospital , Korea (South) SOL KI KIM
▶ Correct Answer as Differential Diagnosis : 18/66,  27.3%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - Beaulieu clinic Geneva , Switzerland GILLES GENIN
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Chonnam National University Hospital , Korea (South) SEUNGYOON CHAE
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Japan KAZUMA TERAUCHI
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
▶ Semi-Correct Answer : 11/66,  16.7%
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Lilavati Hospital , India DHRUV UMESH SHARMA
  • - , Japan HIROAKI ARAKAWA
  • - Other , Korea (South) KYU-CHONG LEE
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