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Weekly Chest CasesArchive of Old Cases

Case No : 1427 Date 2025-02-24

  • Courtesy of Jinwoo Son, Na Young Kim, Hye-Jeong Lee / Severance Hospital
  • Age/Sex 68 / F
  • Chief ComplaintWeight loss, abnormal chest X-rau
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Pulmonary cryptococcosis
Radiologic Findings
Fig 1. Chest PA shows multiple nodules and consolidation in the left lung with upper zone dominancy.
Fig 2-6. CT scan shows multifocal tiny centrilobular nodules with branching opacities, hypoattenuated nodules and nodular consolidations in the left upper lobe and left lower lobe superior segment. No mediastinal lymphadenopathy nor pleural effusion.
Brief Review
Cryptococcus can infect any tissue or organ in the human body, with the respiratory system being the most frequently affected, followed by the central nervous system and the skin. Pulmonary cryptococcosis is a fungal pulmonary disease caused by Cryptococcus infection. Cryptococcal infection can occur in individuals with normal immunity but is most common in the immunocompromised host. Cryptococcal spores are dormant or disseminated in the human body due to the different immune statuses of patients, resulting in different clinical characteristics.
Pulmonary cryptococcosis can present with various radiological patterns, including lung nodules or mass-like lesions. In immunocompetent patients, the most common findings on CT include multiple, small (<10 mm), well-defined pulmonary nodules with smooth margins, predominantly located in the middle and upper lung zones. These nodules typically involve less than 10% of the lung parenchyma. These nodules frequently mimic lung cancer or tuberculosis, necessitating histopathological confirmation for accurate diagnosis. Less commonly, CT may reveal masses, areas of consolidation, lymphadenopathy, pleural effusion, or cavitation. In contrast, immunocompromised patients tend to experience a more widespread thoracic disease with interstitial lung pattern and enlarged lymph nodes.
Although antifungal therapy can significantly improve clinical symptoms, radiological resolution is often slow, with lung lesions persisting for an extended period, even after successful treatment
References
1. Wang DX, Zhang Q, Wen QT, Ding GX, Wang YG, Du FX, Zhang TY, Zheng XY, Cong HY, Du YL, Sang JZ, Wang MD, Zhang SX. Comparison of CT findings and histopathological characteristics of pulmonary cryptococcosis in immunocompetent and immunocompromised patients. Sci Rep. 2022 Apr 5;12(1):5712. doi: 10.1038/s41598-022-09794-6.
2. Kishi K, Homma S, Kurosaki A, Kohno T, Motoi N, Yoshimura K. Clinical features and high-resolution CT findings of pulmonary cryptococcosis in non-AIDS patients. Respir Med. 2006 May;100(5):807-12. doi: 10.1016/j.rmed.2005.09.017.
Keywords

No. of Applicants : 61

▶ Correct Answer : 7/61,  11.5%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - IUHW Narita Hospital , Japan ISSEI FUKUDA
  • - , France FABIEN CRAIGHERO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Osaka University , Japan AKINORI HATA
  • - Mie university , Japan SHIKO OKABE
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
▶ Correct Answer as Differential Diagnosis : 21/61,  34.4%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Oita university , Japan AYUMI KAMEI
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - , Korea (South) DONG-HO BANG
  • - Other , Korea (South) BYUK GYUNG CHOI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - GHICL , France MANUEL TOLEDANO
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - , Korea (South) NAEUN OH
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
▶ Semi-Correct Answer : 1/61,  1.6%
  • - Kyoto University , Japan SHO KOYASU
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