Tomographic assessment of thoracic fungal diseases: a pattern and signs approach

Abstract

Pulmonary fungal infections, which can be opportunistic or endemic, lead to considerable morbidity and mortality. Such infections have multiple clinical presentations and imaging patterns, overlapping with those of various other diseases, complicating the diagnostic approach. Given the immensity of Brazil, knowledge of the epidemiological context of pulmonary fungal infections in the various regions of the country is paramount when considering their differential diagnoses. In addition, defining the patient immunological status will facilitate the identification of opportunistic infections, such as those occurring in patients with AIDS or febrile neutropenia. Histoplasmosis, coccidioidomycosis, and paracoccidioidomycosis usually affect immunocompetent patients, whereas aspergillosis, candidiasis, cryptococcosis, and pneumocystosis tend to affect those who are immunocompromised. Ground-glass opacities, nodules, consolidations, a miliary pattern, cavitary lesions, the halo sign/reversed halo sign, and bronchiectasis are typical imaging patterns in the lungs and will be described individually, as will less common lesions such as pleural effusion, mediastinal lesions, pleural effusion, and chest wall involvement. Interpreting such tomographic patterns/signs on computed tomography scans together with the patient immunological status and epidemiological context can facilitate the differential diagnosis by narrowing the options.

Imaging features of fungal pneumonia in haematopoietic stem cell transplant patients

“…The prophylactic use of "azole" medications (such as fluconazole) has significantly decreased the rate of Candida species infections (candidiasis) in HSCT patients. The appearance of candidiasis pneumonia overlaps significantly with those discussed previously: nodules, consolidation; possible ground-glass halo; and less common patterns include cavitations and miliary nodules (Figure 4) [6,27].…”

“…Pneumocystis jirovecii pneumonia (PJP) has declined in recent years due to the use of routine post-HSCT trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis [ 3 ]. The most common radiological appearance of PJP on CT is upper lobe predominant (although it may also be diffuse), generally peripheral sparing, ground-glass opacities (with or without air-filled cysts), which directly reflects the histopathology of infectious organism causing intra-alveolar accumulation of fibrin and cellular debris [ 27 ]. The thin-walled, air-filled cysts can decrease in size and potentially resolve after initiation of treatment, and can also spontaneously rupture, resulting in a pneumothorax [ 28 ].…”

Esophagectomy in a patient with pulmonary histoplasmosis: A case report of surgical aspects and complications (with video)

“…To the best of our knowledge, this is the first case report of esophageal cancer on a patient with a history of pulmonary histoplasmosis. As with other systemic fungal diseases, infection by histoplasma capsulatum may have a variety of manifestations—the most common includes multiple lung nodules [ 6 ], which must be differentiated from those of metastatic origin. These often present a challenge in this regard during staging [ [7] , [8] , [9] ].…”

Initial chest X-ray findings in pediatric patients diagnosed with H1N1 virus infection

“…Most recent articles about thoracic radiology in infectious diseases address aspects of CT ( 8 - 11 ) . However, chest X-ray still plays an important role, especially in pediatric patients ( 12 ) .…”