Clinical features and high-resolution CT findings of pulmonary cryptococcosis in non-AIDS patients

Abstract

The objective of this study was to clarify clinical and high-resolution computed tomography (HRCT) characteristics in non-AIDS patients with pulmonary cryptococcosis. We analyzed the medical records and HRCT scans in 22 patients with pulmonary cryptococcosis from 1988 to 2003. Thirteen patients (59%) were immunocompetent and nine (41%) were immunosuppressed, seven of whom had diabetes mellitus. No patients exhibited extrapulmonary involvement. Nineteen patients (86%) were asymptomatic. Radiography revealed incidental chest abnormality in all but two patients. The typical HRCT findings were solitary or multiple nodules in the subpleural area. Cavitation was present in 30% of the patients who had nodules. The most frequently applied and reliable diagnostic procedure was video-assisted thoracoscopic surgery (VATS). Treatment included antifungal therapy alone in 11 patients, surgery alone in eight including four treated by VATS, surgery plus antifungal therapy in two and none in one. Patients who underwent surgery alone did not develop any relapse. The majority of non-AIDS patients with pulmonary cryptococcosis present with incidental chest radiographic abnormalities. The most common HRCT findings are solitary or multiple nodules with or without cavitation in the subpleural areas of the lung. VATS is a useful tool for both diagnosis and treatment of isolated pulmonary cryptococcosis.

Plain and contrast‑enhanced chest computed tomography scan findings of pulmonary cryptococcosis in immunocompetent patients

“…The majority of patients in the current study presented with respiratory symptoms, including coughing (33.33%), expectoration (22.22%), fever (18.52%) and chest pain (14.81%), while only 3 patients (11.11%) were asymptomatic. In contrast to the present study, Kishi et al (10) reported that approximately one-third of immunocompetent patients with pul monary cryptococcosis were asymptomatic. Depending on the host immune status, cryptococcosis may disseminate from the lungs to other organs, including the CNS and brain.…”

“…These aforementioned findings were similar to those of previous studies (23,28,29). Pulmonary cavitation has been more rarely reported in immunocompetent patients compared with immunocompromised patients (10). It has also been reported that cavitation demonstrates a long-term localized pulmonary abnormality, indicating that patients with cavitary pulmonary lesions may experience a more severe cryptococcal infection that requires a more aggressive antifungal therapy (31).…”

“…The clinical expression is variable and may present as coughing, expectoration, chest tightness, fever or asymptomatic. The most common radiological characteristics are known to be solitary or multiple pulmonary nodules, and segmental or lobar consolidation (10,11). For these reasons, pulmonary cryptococcosis is frequently misdiagnosed as other lung diseases, such as cancer and pneumonia.…”

Solitary pulmonary nodule in the liver transplant candidate: Importance of diagnosis and treatment

“…In one study using high-resolution CT, pulmonary nodules 10 mm with ground-glass opacity were considered to have a high possibility of malignancy and to be candidates for lung resection. 18 VATS is the recommended diagnostic and therapeutic approach in the management of SPNs due to cryptoccocosis 14 and small SPNs to rule out malignancy if a definite diagnosis by noninvasive imaging cannot be made. 18 Needle localization 19 and radiolabeled technetium localization 20 of small tumors with CT are reliable for identifying tumors for biopsy or wedge resection during thoracoscopy and may prevent the need for open thoracotomy.…”

Cavitary Pulmonary Disease

“…At least one study demonstrated a significantly higher frequency of cavitation by lung computed tomography among immunocompromised patients with cryptococcal lung infection (62.5%) than among immunocompetent patients (15.4%), but none of the immunocompromised patients in that study had human immunodeficiency virus infection (52). On the whole, cavitation appears to be more common among persons with mild to moderate immune compromise, such as that caused by diabetes, cirrhosis, or corticosteroid therapy, than among immunocompetent hosts (2,187,192). However, persons with severe immune compromise due to human immunodeficiency virus infection rarely have cavitary pulmonary cryptococcal infection; interstitial infiltrates and hilar lymphadenopathy are more common in this patient population (249,384).…”