Jibo Hu, Hongjie Hu, Susu Xie, Xiaoming Yang, Yaoying Zhong and Yijie Shi Pages 83 - 88 ( 6 )
Objective: Primary pulmonary cryptococcosis in immunocompetent patients is very easily misdiagnosed or even missed. Accurate diagnosis of this disease is critical for a timely and proper treatment. This study aims to address the importance of computed tomography (CT) and CT-guided percutaneous needle biopsy for primary pulmonary cryptococcosis in immunocompetent patients.Methods: We retrospectively analyzed clinical features and CT findings of 36 immunocompetent patients with pathologically confirmed primary pulmonary cryptococcosis. CT-guided percutaneous pulmonary needle biopsies were performed in 25 of these patients. Results: Nineteen patients were symptomatic, including cough, chest pain, expectoration, bloody sputum or hemoptysis, and fatigue. Seventeen patients were asymptomatic. CT examinations displayed a single-lobe lesion in 29 cases and multiple-lobe lesions in 7 cases. Lesions were located in the outer zone in 33 cases, and in the middle zone in 3 cases. CT findings were primarily classified into 2 types: solitary nodule (10 cases, 27.8%) and localized multiple miscellaneous nodule or consolidation (26 cases, 72.2%). In addition, air-bronchograms within the lesions, irregular cavitations and halo signs were found in 21, 8 and 10 cases, respectively. Twenty two (88%) of 25 CT-guided percutaneous pulmonary needle biopsies were confirmed to be pulmonary cryptococcosisby pathology. Conclusions: CT findings of localized multiplemiscellaneous nodules or consolidations with airbronchograms, or cavitations, or halo signs, strongly support the presence of primary pulmonary cryptococcosis. CT-guided percutaneous needle biopsy helps with the accurate diagnosis of this disease.
Pulmonary cryptococcosis, Immunocompetent, CT imagings, CT guided biopsy, Diagnosis.
Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016