Abstract | PURPOSE: We aimed to investigate clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment. MATERIALS AND METHODS: We retrospectively reviewed the medical records, initial and follow-up chest computed tomography scans and/or radiographs for initial clinical and radiologic manifestations and outcomes following antifungal treatment of 12 immunocompetent patients diagnosed with pulmonary cryptococcosis between 1990 and 2012. RESULTS: Twelve patients (age range, 21-62 years; males, eight patients [66.7%]) were included. Nine (75%) patients were symptomatic, eight of whom had disseminated infection with central nervous system involvement. Initial pulmonary abnormalities consisted of single nodules/masses (n=5), single segmental or lobar mass-like consolidation (n=3), multiple cavitary and noncavitary nodules (n=1), and multifocal consolidation plus nodules (n=3). These lesions ranged from less than 1 cm to 15 cm in greatest diameter. Distinct subpleural and lower lung predominance was observed. Seven patients (58.3%) had one or more atypical/aggressive findings, namely endobronchial obstruction (n=4), calcified (n=1) or enlarged (n=4) mediastinal/hilar lymph nodes, vascular compression (n=1), pericardial involvement (n=1), and pleural involvement (n=2). Following antifungal therapy, radiologic resolution was variable within the first six months of eight nonsurgical cases. Substantial (>75%) improvement with some residual abnormalities, bronchiectasis, cavitation, and/or fibrotic changes were frequently observed after 12-24 months of treatment (n=6). CONCLUSION: Pulmonary cryptococcosis in immunocompetent patients frequently causes disseminated infection with atypical/aggressive radiologic findings that are gradually and/or incompletely resolved after treatment. The presence of nonenhanced low-attenuation areas within subpleural consolidation or mass and the absence of tree-in-bud appearance should raise concern for pulmonary cryptococcosis, particularly in patients presenting with meningitis.
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Authors | Thitiporn Suwatanapongched, Wasinan Sangsatra, Viboon Boonsarngsuk, Siriorn P Watcharananan, Pimpin Incharoen |
Journal | Diagnostic and interventional radiology (Ankara, Turkey)
(Diagn Interv Radiol)
2013 Nov-Dec
Vol. 19
Issue 6
Pg. 438-46
ISSN: 1305-3612 [Electronic] Turkey |
PMID | 23864332
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Adult
- Airway Obstruction
(diagnostic imaging, etiology)
- Antifungal Agents
(therapeutic use)
- Bronchiectasis
(diagnostic imaging, etiology)
- Calcinosis
(diagnostic imaging, etiology)
- Cryptococcosis
(complications, diagnostic imaging, drug therapy)
- Female
- Humans
- Immunocompetence
- Lung Diseases, Fungal
(complications, diagnostic imaging, drug therapy)
- Lymphatic Diseases
(diagnostic imaging, etiology)
- Male
- Middle Aged
- Pulmonary Fibrosis
(diagnostic imaging, etiology)
- Retrospective Studies
- Tomography, X-Ray Computed
- Young Adult
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