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Weekly Chest CasesArchive of Old Cases

Case No : 1445 Date 2025-06-30

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  • 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
Keywords

No. of Applicants : 71

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