Weekly Chest CasesArchive of Old Cases

Case No : 899 Date 2015-01-19

  • Courtesy of Geewon Lee, Ji Won Lee / Pusan National University Hospital
  • Age/Sex 76 / M
  • Chief ComplaintChest CT abnormalities, which were incidentally found at abdominal CT. History of steroid therapy for 6 months due to nephrotic syndrome.
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Diagnosis With Brief Discussion

Diagnosis
Nocardiosis
Radiologic Findings
Contrast-enhanced chest CT images showed several subpleural nodules and consolidation with internal low density at both lower lobes. Enlarged paraaotic lymph nodes with internal necrosis were also noted. Contrast-enhanced brain MR images demonstrated a small peripheral enhancing lesion at the left parietal lobe, suggesting a microabscess.
Brief Review
Nocardia is an aerobic gram (+) bacilli which causes pneumonia in patients with deficits in cell-mediated immunity such as those with AIDS, transplant recipients, and receiving corticosteroid therapy. Pulmonary nocardiosis can present with signs and symptoms similar to those of pulmonary tuberculosis such as fever, chills, fatigue, dyspnea, productive cough, hemoptysis, sweats, and weight loss. Disseminated nocardiosis occurs through hematogenous spread from the lungs most commonly to the CNS, skin, and joints.
On chest CT images, multifocal lung consolidation with decreased attenuation, and possible cavitation is the predominant finding. Nocardiosis can also manifest as nodules and masses, pleural or chest wall involvement due to direct extension. Differential diagnosis for pulmonary nocardiosis includes other causes of lung consolidation, cavitation, and nodules such as other infections, vasculitis, and malignancy. Actinomycosis can have similar CT appearance to that of Nocardia, but actinomycosis does not become disseminated to involve the CNS.
Treatment for pulmonary nocardiosis is sulfa-containing antibiotics, and possible surgery or drainage for extensive lung destruction.
Please refer to
Case 76, Case 117, Case 549, Case 630,
KSTR Imaging Conference 2011 Summer  Case 3 ,
KSTR Imaging Conference 2008 Summer  Case 6 ,
KSTR Imaging Conference 2002 Spring  Case 4 ,
KSTR Imaging Conference 2001 Spring  Case 11 ,
KSTR Symposium 1999  Case 8 ,
KSTR Symposium 1998  Case 10,
References
1. Kanne JP, Yandow DR, Mohammed TL et-al. CT findings of pulmonary nocardiosis. AJR Am J Roentgenol. 2011;197 (2): W266-72.
2. Rosado-de-christenson: Diagnostic imaging. Chest. 2010; 4:38-39
Keywords
Lung, Mediastinum, Infection, Bacterial infection,

No. of Applicants : 72

▶ Correct Answer : 12/72,  16.7%
  • - Pamukkale University, School of Medicine, Dept. of Radiology , Turkey Nevzat Karabulut
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Haeundae Paik Hospital , Korea (South) In Chul Nam
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - UZA , Belgium Eline De Smet
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - Ibaraki-gazou-shindan , Japan Shoichi Katoh
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Fukuyama City Hospital , Japan Mayu Uka
▶ Correct Answer as Differential Diagnosis : 20/72,  27.8%
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - GHICL , France manuel toledano
  • - McGill University Health Center , Canada Alexandre Semionov
  • - SNUH , Korea (South) Eui Jin Hwang
  • - IRSA La Rochelle , France Denis Chabassiere
  • - Niigata University , Japan Atsushi Uehara
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - CHU Poitiers , France CHAN paul
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Seoul National University Hospital , Korea (South) Sunkyung Jeon
  • - Seoul university hospital , Korea (South) Youngjin Ryu
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - CHU POITIERS , France SZTARK Guillaume
  • - All India Institute of medical sciences , India Justin Moses
  • - Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
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