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Pulmonary Cryptococcosis: Imaging Findings in 23 Non-AIDS Patients

  • Song, Kyoung-Doo (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Kyung-Soo (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chung, Man-Pyo (Division of Pulmonary and Critical Care Medicine at the Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kwon, O-Jung (Division of Pulmonary and Critical Care Medicine at the Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Tae-Sung (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yi, Chin-A (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chung, Myung-Jin (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2009.12.28
  • 심사 : 2010.02.16
  • 발행 : 2010.08.01

초록

Objective: We aimed to review the patterns of lung abnormalities of pulmonary cryptococcosis on CT images, position emission tomography (PET) findings of the disease, and the response of lung abnormalities to the therapies in non-AIDS patients. Materials and Methods: We evaluated the initial CT (n = 23) and 18F-fluorodeoxyglucose (FDG) PET (n = 10), and follow-up (n = 23) imaging findings of pulmonary cryptococcosis in 23 non-AIDS patients. Lung lesions were classified into five patterns at CT: single nodular, multiple clustered nodular, multiple scattered nodular, mass-like, and bronchopneumonic patterns. The CT pattern analyses, PET findings, and therapeutic responses were recorded. Results: A clustered nodular pattern was the most prevalent and was observed in 10 (43%) patients. This pattern was followed by solitary pulmonary nodular (n = 4, 17%), scattered nodular (n = 3, 13%), bronchopneumonic (n = 2, 9%), and single mass (n = 1, 4%) patterns. On PET scans, six (60%) of 10 patients showed higher FDG uptake and four (40%) demonstrated lower FDG uptake than the mediastinal blood pool. With specific treatment of the disease, a complete clearance of lung abnormalities was noted in 15 patients, whereas a partial response was noted in seven patients. In one patient where treatment was not performed, the disease showed progression. Conclusion: Pulmonary cryptococcosis most commonly appears as clustered nodules and is a slowly progressive and slowly resolving pulmonary infection. In two-thirds of patients, lung lesions show high FDG uptake, thus simulating a possible malignant condition.

키워드

과제정보

연구 과제 주관 기관 : KOSEF

참고문헌

  1. Sarosi GA. Cryptococcal pneumonia. Semin Respir Infect 1997;12:50-53
  2. Woodring JH, Ciporkin G, Lee C, Worm B, Woolley S. Pulmonary cryptococcosis. Semin Roentgenol 1996;31:67-75 https://doi.org/10.1016/S0037-198X(96)80041-1
  3. Levitz SM. The ecology of Cryptococcus neoformans and the epidemiology of cryptococcosis. Rev Infect Dis 1991;13:1163-1169 https://doi.org/10.1093/clinids/13.6.1163
  4. Miller WT Jr, Edelman JM, Miller WT. Cryptococcal pulmonary infection in patients with AIDS: radiographic appearance. Radiology 1990;175:725-728 https://doi.org/10.1148/radiology.175.3.2343121
  5. Meyohas MC, Roux P, Bollens D, Chouaid C, Rozenbaum W, Meynard JL, et al. Pulmonary cryptococcosis: localized and disseminated infections in 27 patients with AIDS. Clin Infect Dis 1995;21:628-633 https://doi.org/10.1093/clinids/21.3.628
  6. Friedman EP, Miller RF, Severn A, Williams IG, Shaw PJ. Cryptococcal pneumonia in patients with the acquired immunodeficiency syndrome. Clin Radiol 1995;50:756-760 https://doi.org/10.1016/S0009-9260(05)83214-3
  7. Lacomis JM, Costello P, Vilchez R, Kusne S. The radiology of pulmonary cryptococcosis in a tertiary medical center. J Thorac Imaging 2001;16:139-148 https://doi.org/10.1097/00005382-200107000-00001
  8. Khoury MB, Godwin JD, Ravin CE, Gallis HA, Halvorsen RA, Putman CE. Thoracic cryptococcosis: immunologic competence and radiologic appearance. AJR Am J Roentgenol 1984;142:893-896 https://doi.org/10.2214/ajr.142.5.893
  9. Zinck SE, Leung AN, Frost M, Berry GJ, Mu ller NL. Pulmonary cryptococcosis: CT and pathologic findings. J Comput Assist Tomogr 2002;26:330-334 https://doi.org/10.1097/00004728-200205000-00002
  10. Fox DL, Muller NL. Pulmonary cryptococcosis in immunocompetent patients: CT findings in 12 patients. AJR Am J Roentgenol 2005;185:622-626 https://doi.org/10.2214/ajr.185.3.01850622
  11. Lindell RM, Hartman TE, Nadrous HF, Ryu JH. Pulmonary cryptococcosis: CT findings in immunocompetent patients. Radiology 2005;236:326-331 https://doi.org/10.1148/radiol.2361040460
  12. Aberg JA, Mundy LM, Powderly WG. Pulmonary cryptococcosis in patients without HIV infection. Chest 1999;115:734-740 https://doi.org/10.1378/chest.115.3.734
  13. Nadrous HF, Antonios VS, Terrell CL, Ryu JH. Pulmonary cryptococcosis in nonimmunocompromised patients. Chest 2003;124:2143-2147 https://doi.org/10.1378/chest.124.6.2143
  14. Huang CJ, You DL, Lee PI, Hsu LH, Liu CC, Shih CS, et al. Characteristics of integrated 18F-FDG PET/CT in pulmonary cryptococcosis. Acta Radiol 2009;50:374-378 https://doi.org/10.1080/02841850902756532
  15. Vinson AE, Solis V, Williams HT, Bell B. F-18-FDG-PET/CT leads to diagnosis of cryptococcal pneumonia where recurrent metastatic rhabdomyosarcoma was suspected. Clin Nucl Med 2007;32:401-403 https://doi.org/10.1097/01.rlu.0000259630.99988.d3
  16. Igai H, Gotoh M, Yokomise H. Computed tomography (CT) and positron emission tomography with [18f]fluoro-2-deoxy-Dglucose (FDG-PET) images of pulmonary cryptococcosis mimicking lung cancer. Eur J Cardiothorac Surg 2006;30:837-839 https://doi.org/10.1016/j.ejcts.2006.09.022
  17. Hsu CH, Lee CM, Wang FC, Lin YH. F-18 fluorodeoxyglucose positron emission tomography in pulmonary cryptococcoma. Clin Nucl Med 2003;28:791-793 https://doi.org/10.1097/01.rlu.0000082680.98898.2b
  18. Webb WR, Muller NL, Naidich DP. High-resolution CT of the lung, 4th ed. Philadelphia: Lippincott Williams & Wilkins, PA 2009
  19. Shim SS, Lee KS, Kim BT, Chung MJ, Lee EJ, Han J, et al. Nonsmall cell lung cancer: prospective comparison of integrated FDG PET/CT and CT alone for preoperative staging. Radiology 2005;246:1011-1019
  20. Kim YK, Lee KS, Kim BT, Choi JY, Kim H, Kwon OJ, et al. Mediastinal nodal staging of nonsmall cell lung cancer using integrated 18F-FDG PET/CT in a tuberculosis-endemic country: diagnostic efficacy in 674 patients. Cancer 2007;109:1068-1077 https://doi.org/10.1002/cncr.22518
  21. Chang WC, Tzao C, Hsu HH, Lee SC, Huang KL, Tung HJ, et al. Pulmonary cryptococcosis: comparison of clinical and radiographic characteristics in immunocompetent and immunocompromised patients. Chest 2006;129:333-340 https://doi.org/10.1378/chest.129.2.333
  22. Shim SS, Lee KS, Kim BT, Choi JY, Chung MJ, Lee EJ. Focal parenchymal lung lesions showing a potential of false-positive and false-negative interpretations on integrated PET/CT. AJR Am J Roentgenol 2006;186:639-648 https://doi.org/10.2214/AJR.04.1896
  23. Cheon JE, Im JG, Kim MY, Lee JS, Choi GM, Yeon KM. Thoracic actinomycosis: CT findings. Radiology 1998;209:229-233 https://doi.org/10.1148/radiology.209.1.9769836
  24. Aquino SL, Kee ST, Warnock ML, Gamsu G. Pulmonary aspergillosis: imaging findings with pathologic correlation. AJR Am J Roentgenol 1994;163:811-815 https://doi.org/10.2214/ajr.163.4.8092014
  25. Kim SY, Lee KS, Han J, Kim J, Kim TS, Choo SW, et al. Semiinvasive pulmonary aspergillosis: CT and pathologic findings in six patients. AJR Am J Roentgenol 2000;174:795-798 https://doi.org/10.2214/ajr.174.3.1740795

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  2. Two Cases of Cryptococcuria Developed as Isolated Cryptococcuria and Disseminated Cryptococcosis vol.14, pp.4, 2010, https://doi.org/10.5145/kjcm.2011.14.4.148
  3. Pulmonary Cryptococcosis Mimicking Primary Lung Cancer with Multiple Lung Metastases vol.73, pp.3, 2010, https://doi.org/10.4046/trd.2012.73.3.182
  4. Primary pulmonary cryptococcosis: evaluation of CT characteristics in 26 immunocompetent Chinese patients vol.53, pp.6, 2010, https://doi.org/10.1258/ar.2012.110612
  5. Utility of 18F-FDG PET/CT in Diagnosis and Management of Mucormycosis vol.38, pp.9, 2010, https://doi.org/10.1097/rlu.0b013e3182867d13
  6. Pulmonary cryptococcosis: An unusual presentation vol.30, pp.4, 2010, https://doi.org/10.4103/0970-2113.120618
  7. Fatal Disseminated Cryptococcus Infection in an Immunocompetent Patient vol.9, pp.3, 2010, https://doi.org/10.5812/archcid.20246
  8. Pulmonary Cryptococcosis That Mimicked Rheumatoid Nodule in Rheumatoid Arthritis Lesion vol.77, pp.6, 2010, https://doi.org/10.4046/trd.2014.77.6.266
  9. Pulmonary cryptococcosis: comparison of CT findings in immunocompetent and immunocompromised patients vol.56, pp.4, 2015, https://doi.org/10.1177/0284185114529105
  10. Significant pulmonary disease burden in treatment resistant disseminated cryptococcal infection: A case report vol.33, pp.4, 2010, https://doi.org/10.1007/s12055-017-0545-7
  11. Cryptococcal pneumonia: the great mimicker vol.3, pp.2, 2010, https://doi.org/10.1259/bjrcr.20150358
  12. A unique case report of endobronchial cryptococcosis and review of the literature vol.25, pp.None, 2010, https://doi.org/10.1016/j.rmcr.2018.09.014
  13. Infectious pneumonia in immunocompetent patients: updates in clinical and imaging features vol.2, pp.3, 2010, https://doi.org/10.23838/pfm.2018.00079
  14. Pleural fluid secondary to pulmonary cryptococcal infection: a case report and review of the literature vol.19, pp.1, 2010, https://doi.org/10.1186/s12879-019-4343-2
  15. An exceptional case report of disseminated cryptococcosis in a hitherto immunocompetent patient vol.62, pp.None, 2010, https://doi.org/10.1590/s1678-9946202062003
  16. CT Halo sign: A systematic review vol.124, pp.None, 2010, https://doi.org/10.1016/j.ejrad.2020.108843
  17. Should we perform the serum cryptococcal antigen test in people living with HIV hospitalized due to a community-acquired pneumonia episode? vol.31, pp.4, 2010, https://doi.org/10.1177/0956462419847161
  18. Possible environmental exposure-associated pulmonary cryptococcosis in a patient with rheumatoid arthritis: a case report and literature review vol.48, pp.10, 2020, https://doi.org/10.1177/0300060520962302
  19. Clinical analysis in immunocompetent and immunocompromised patients with pulmonary cryptococcosis in western China vol.10, pp.None, 2020, https://doi.org/10.1038/s41598-020-66094-7
  20. Clinical and Computed Tomography (CT) Characteristics of Pulmonary Nodules Caused by Cryptococcal Infection vol.14, pp.None, 2010, https://doi.org/10.2147/idr.s330159
  21. Comparison of clinical features of pulmonary cryptococcosis with and without central nervous system involvement in China vol.49, pp.2, 2010, https://doi.org/10.1177/0300060521991001