Revisão radiológica de 173 casos consecutivos de paracoccidioidomicose

Abstract

OBJECTIVE: To determine the incidence of most significant radiological findings of paracoccidioidomycosis and to verify its possible variants. MATERIALS AND METHODS: One hundred and seventy-three cases of paracoccidioidomycosis presented between 1970 and 1980 were reviewed, including their radiological workup reanalysis by at least two experienced radiologists.RESULTS: Ninety-four cases were pulmonary only and 38 were pulmonary associated with ganglial, visceral and osseous lesions or in association with tuberculosis. There was no pulmonary involvement in 41 cases, with small bowel, viscera, bone lesions, or a combination of these. Most significant radiological findings in cases of pulmonary involvement were bilateral, diffuse reticular and nodular interstitial infiltrate, followed by the diffuse bilateral alveolar form. Visceral and gastrointestinal tract lesions presented predominantly with liver, jejunum and ileum involvement.Lymph nodal involvement was predominantly diffuse, abdominal or peripheral. In bones, osteolytic lesions affected predominantly long bones and clavicle. CONCLUSION: Paracoccidioidomycosis is a granulomatous disease commonly found in Brazil, primarily affecting lungs, caused by inhalation of fungus spores. Other rare or less frequent forms of the disease should be taken into consideration for differential diagnosis.

Pulmonary Paracoccidioidomycosis: Clinical, Immunological and Histopathological Aspects

“…Emphysema was reported in 34.1%, septal lines by 25.7%, pleural thickening by 7.5%. Nine cases (6.8%) presented cavitations and three cases (2.2%) giant nodules or masses (Trad et al, 2006). CT proved superior to conventional radiographs in demonstrating early interstitial reticular and nodular infiltrates and showed abnormal findings in the majority of patients with chronic pulmonary PCM (more than 93%).…”

“…In humans, assessment of disease progression and treatment outcome normally includes chest x-rays and then CT studies. At the time of diagnosis and in patients with active disease, chest x-ray revealed interstitial and alveolar-interstitial infiltrates, often bilateral and symmetrical, occasionally confluent, located preferentially in the central and basal areas of the lung (pattern in butterfly wings) (do Valle et al, 1992;Trad et al, 2006). A study of radiological monitoring carried out in 173 patients with chronic PCM reported presence of reticular interstitial infiltrates in 89.3% of the cases and nodular in 54.5%, bilateral alveolar in 45.4%, and mixed (in butterfly wings) in 44.7%.…”

Which is your diagnosis?

“…In endemic areas, the finding of bilateral and symmetrical opacities in the central regions of the lungs in association with emphysema in the lung bases is suggestive of the disease. In chronic pulmonary PCM, architectural distortion, paracicatricial emphysema and traction bronchiectasis represent common manifestations of fibrosis (9,10) .…”

“…Bone involvement in PCM is uncommon and results primarily from hematogenous dissemination of the disease. A review of 173 consecutive cases of acute and chronic PCM has shown bone lesions in only 1.7% of cases (9) . In spite of being rare, bone or joint lesions occur most frequently in cases of the juvenile presentation of the disease, particularly in children (16)(17)(18) .…”

Pulmonary paracoccidoidomycosis: radiology and clinical-epidemiological evaluation

“…Chest X-ray is frequently abnormal in patients with PCM and shows non-specific lung changes. However, the correlation of radiological abnormalities with respiratory symptoms in patients with PCM is not well known 8,9 .…”