대한흉부영상의학회 Weekly Chest Cases

Case No : 1227 Date 2021-04-26

Courtesy of Jongmin Park, Jae-kwang Lim / Kyungpook National University Hospital
Age/Sex 63 / M
Chief ComplaintFever, myalgia, dry cough (onset of fever: 10 days ago) Lived in the United States for 35 years

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Diagnosis With Brief Discussion

Diagnosis: Coccidioidomycosis
Radiologic Findings: In our patient, chest radiography demonstrated widely distributed nodules and ground-glass opacities throughout both lung fields.
Axial and coronal chest computed tomography showed diffuse innumerable small nodules with random distribution and multifocal ground-glass opacities in both lungs. Several borderline-sized lymph nodes were seen in the mediastinum, suggestive of reactive hyperplasia. No pleural effusion or cardiac abnormality was seen.
The patient has lived in the United States for 35 years. Surgical biopsy of the right lower lobe was performed for the diagnosis of lung disease, and the final diagnosis was confirmed to be pulmonary coccidioidomycosis.
Brief Review: Coccidioidomycosis is a fungal infection caused by inhalation of the spores of Coccidioides species, which are endemic to the southwestern United States and arid regions of Mexico, Central America, and South America. The lungs are the target organ in coccidioidomycosis and are involved in a wide spectrum of clinical and imaging manifestations that are categorized as acute, disseminated, or chronic disease. Acute coccidioidomycosis is responsible for up to 29% of community-acquired pneumonia cases in endemic areas and is mostly self-limiting. Disseminated or chronic disease occurs in a minority of cases and is associated with significant morbidity and mortality.
The classic pulmonary manifestation of disseminated coccidioidal infection is the presence of miliary nodules caused by hematogenous spread. The original focus of parenchymal consolidation is occasionally seen, and hilar and mediastinal adenopathies are usually present. Lung nodules often progress to confluent opacities. Acute respiratory distress syndrome (ARDS) is an infrequent complication that occurs in immunocompromised hosts. Patients with acquired immunodeficiency syndrome are at an increased risk of developing fungemia and ARDS. Diffuse or dependent lung opacities may be associated with ARDS. Even with antifungal and supportive therapy, these patients have a high mortality rate approaching 100%. ARDS may also occur in immunocompetent patients or in individuals with other preexisting conditions, such as diabetes or renal failure, with a mortality rate of 40%–60%.
Please refer to
References: 1. Jude, Cecilia M., et al. "Pulmonary coccidioidomycosis: pictorial review of chest radiographic and CT findings." Radiographics 34.4 (2014): 912-925.
2. Crum NF, Lederman ER, Stafford CM, Parrish JS, Wallace MR. Coccidioidomycosis: a descriptive survey of a reemerging disease—clinical characteristics and current controversies. Medicine (Baltimore) 2004;83(3):149–175
3. Valdivia L, Nix D, Wright M, et al. Coccidioidomycosis as a common cause of community-acquired pneumonia. Emerg Infect Dis 2006;12(6): 958–962.
4. Batra P, Batra RS. Thoracic coccidioidomycosis. Semin Roentgenol 1996;31(1):28–44
Keywords

No. of Applicants : 97

▶ Correct Answer : 24/97, 24.7%

- , Japan HIROAKI ARAKAWA
- ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
- Showa General Hospital , Japan MASAFUMI KAIUME
- Mayo Clinic , United States AKITOSHI INOUE
- , Japan CHIAKI SATO
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Ajou University Hospital , Korea (South) KYUNGMIN LEE
- Other , Korea (South) SEONGSU KANG
- Hamamatsu University Hospital , Japan HAYATO NOZAWA
- National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
- HHS , Canada S LEE
- , Japan KANAE TAKAHASHI
- Kyoto University , Japan HIROSHI TAGAWA
- Osaka City General Hospital , Japan SHU MATSUSHITA
- AIMS , India NITHYA HARIDAS MALIYAM
- Seoul National University Hospital , Korea (South) SE WOO KIM
- , Japan HIROAKI ARAKAWA
- Wuhan Union Hospital , China QIGUANG CHENG
- University of Tsukuba Hospital , Japan SODAI HOSHIAI
- Toranomon Hospital , Japan KAORU SUMIDA
- The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
- , Japan TOMOKI IMOKAWA
- Private sector , Greece VASILIOS TZILAS
- , Japan YUKI HAYASHI

▶ Correct Answer as Differential Diagnosis : 21/97, 21.6%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- Ajou University Hospital , Korea (South) SUNG HYUN AN
- Other , Korea (South) HYEJIN YANG
- Dhq hospital faisalabad , Pakistan AMMAR AHMED
- Ajou University School of Medicine , Korea (South) JUNG YONG JUN
- The University of Tokyo Hospital , Japan MOTO NAKAYA
- , Italy PAOLO BALDASSARI
- Tiger Gate Hospital , Japan SHIN-ICHI CHO
- Ajou University Hospital , Korea (South) SEUNGJIN HAN
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Seoul National University Bundang Hospital , Korea (South) SUNG HYUN YOON
- Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
- Gifu University Hospital , Japan Yo Kaneko
- Ajou University Hospital , Korea (South) DAYOUNG KIM
- Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- , Japan KAZUMA TERAUCHI
- Columbia asia radiology group , India VIKHYATH SHETTY Y
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Semi-Correct Answer : 7/97, 7.2%

- Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
- Chonbuk National University Hospital , Korea (South) MINGI SHIN
- Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
- McGill , Canada MUTAZ ADNAN KHAIRO
- , Korea (South) EUNJIN LEE
- Kyoto University Hospital , Japan SATOSHI IKEDA
- Hanyang University Hospital , Korea (South) SEUNG JIN YOO

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1227 Date 2021-04-26

Discussion

No. of Applicants : 97