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Weekly Chest CasesArchive of Old Cases

Case No : 1505 Date 2026-08-24

  • Courtesy of Ki Yeol Lee, Hwan Seok Yong / Korea University Guro Hospital
  • Age/Sex 56 / M
  • Chief ComplaintChest CT F/U after colon cancer op.
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Cryptococcosis
Radiologic Findings
Fig 1-2. On contrast-enhanced chest CT performed one year after surgery for colon cancer, n solid nodules (1.7 cm and 0.8 cm) are noted in the right lower lobe, which were not present in preoperative CT (not shown).
Fig 3-4. On PET-CT, the nodules showed increased FDG uptake with SUV values of 12.6 and 9.5.
Brief Review
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. Chang WC, Tzao C, Hsu HH, et al.
Pulmonary cryptococcosis mimicking lung cancer on FDG PET/CT.
Clinical Nuclear Medicine. 2009;34(3):189–191.
2. Chen YK, Shen YY, Kao CH.
Pulmonary cryptococcosis mimicking lung malignancy on FDG PET/CT.
Clinical Imaging. 2012;36(2):115–118.2.
3. Wang SY, Lee KS, Kim TS, et al.
Pulmonary cryptococcosis presenting as a solitary pulmonary nodule: CT and FDG PET findings.
American Journal of Roentgenology (AJR). 2008;190(2):W135–W141.
Keywords

No. of Applicants : 67

▶ Correct Answer : 29/67,  43.3%
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - , Japan HIROKI SAKURADA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
  • - Oita university , Japan AYUMI KAMEI
  • - Kyoto University Hospital , Japan YUSUKE UTSUNOMIYA
  • - , Korea (South) DONG-HO BANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Chiba University Hospital , Japan HIROKI MIYAZAKI
  • - Teikyo University Hospital, Mizonokuchi , Japan TOSHIHIRO FURUTA
  • - Nara Medical University , Japan AYA YAMADA
  • - Otsu Red Cross Hospital , Japan JUN YOSHIDA
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Seoul Medical Center , Korea (South) HANSEUL CHO
  • - , Japan HIROKI SHIMOYAMA
  • - Kyoto University , Japan SHO KOYASU
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - suzhou , China DR. WANG
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 18/67,  26.9%
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - , Korea (South) DONG HEE LEE
  • - , Korea (South) CHAE YOUNG SHIN
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) OHMIN KWON
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , Japan RYOTA INAI
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Fukuoka university , Japan KEISUKE SATO
  • - Ehime University , Japan YUTA SUGIURA
  • - Ehime University , Japan TOMOHISA OKADA
  • - Ehime University , Japan KOTARO MATSUMOTO
  • - , Korea (South) JIYUN KIM
  • - Fukuoka Central Hospital , Japan YUKIHISA TAKAYAMA
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