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Weekly Chest CasesArchive of Old Cases

Case No : 1445 Date 2025-06-30

  • Courtesy of Se Ri Kang, Ji Young Rho / Wonkwang University Hospital
  • Age/Sex 34 / M
  • Chief ComplaintAbrnomal finding on health check up CT
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Pulmonary cryptococcosis
Radiologic Findings
Fig 1. Chest PA shows several nodular opacities, one of which is cavitated, in right lower lung field.
Fig 2-4. CT scans reveals multiple nodules and nodular consolidation in right lower lobe. Most of them domenstrates irregular shape and surrounding ill-defined GGO.
Brief Review
The patient had CT-guided PTNB and the pathology report revealed cryptococcal infection. Cryptococcus neoformans is a globally distributed, yeast-like fungus commonly found in environments such as soil enriched by pigeon droppings and decaying wood. Infection occurs through inhalation of fungal spores, initially causing a lung infection that may disseminate to the central nervous system. This pathogen predominantly affects individuals with compromised immune systems, particularly those with impaired cell-mediated immunity. In contrast, immunocompetent individuals often exhibit minimal or no symptoms, with disease typically confined to the lungs, though severe manifestations and abnormal imaging findings can occasionally develop.
Pulmonary cryptococcosis caused by Cryptococcus neoformans presents with a spectrum of imaging features, including lung nodules or mass-like patterns. In immunocompetent patients, the most frequent computed tomography (CT) findings include multiple small (less than 10 mm), well-circumscribed, and smooth-bordered nodules, predominantly located in the middle and upper lung zones, involving less than 10% of the lung parenchyma. Other features such as masses, areas of consolidation, lymphadenopathy, pleural effusions, and cavitation are uncommon. Conversely, in AIDS patients, the disease is often more extensive, characterized by diffuse interstitial patterns and enlarged lymph nodes. While antifungal treatment can lead to clinical improvement, radiographic resolution is typically slow, and pulmonary lesions may persist long after therapy.
References
1. Song KD, Lee KS, Chung MP, et al. Pulmonary cryptococcosis: imaging findings in 23 non-AIDS patients. Korean J Radiol. 2010;11(4):407-416. doi:10.3348/kjr.2010.11.4.407
2. Lindell, R. M., Hartman, T. E., Nadrous, H. F., & Ryu, J. H. (2005). Pulmonary cryptococcosis: CT findings in immunocompetent patients. Radiology, 236(1), 326–331. https://doi.org/10.1148/radiol.2361040460
Keywords

No. of Applicants : 71

▶ Correct Answer : 38/71,  53.5%
  • - Fukuoka university , Japan KEISUKE SATO
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - , Japan SUZUNE TSUKAMOTO
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - The First Affiliated Hospital of Nanjing Medical University , China TENG ZHANG
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - , Japan JUN YOSHIDA
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Yonsei University,Severance Hospital , Korea (South) JUN GU KANG
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - , Japan SHUNJIRO NOGUCHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Chonbuk National University Hospital , Korea (South) SUBIN LEE
  • - Keio University , Japan FUMIKO YAGI
  • - , Japan HIROKI MIYAZAKI
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Osaka University , Japan AKINORI HATA
  • - , Italy PAOLO BALDASSARI
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - Funabashi General Hospital , Japan MANABU AKIMOTO
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - GHICL , France MANUEL TOLEDANO
  • - IUHW Narita Hospital , Japan ISSEI FUKUDA
  • - Kyoto University , Japan SHO KOYASU
  • - Oita university , Japan AYUMI KAMEI
  • - University of Yamanashi , Japan HIROAKI WATANABE
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Mie university , Japan SHIKO OKABE
  • - , Japan YOSHIKI ISHII
  • - , Japan YUMI MAEHARA
▶ Correct Answer as Differential Diagnosis : 9/71,  12.7%
  • - , Korea (South) HEONSEOK LEE
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Jiangsu province hospital , China WANGJIAN ZHA
  • - Chonbuk National University Hospital , Korea (South) YONG HWAN JO
  • - Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - Chonbuk National University Hospital , Korea (South) SEUNG HO LEE
  • - Kobe Children , Japan SHUHEI NORIMOTO
▶ Semi-Correct Answer : 3/71,  4.2%
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
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