Clinical features and radiological characteristics of pulmonary cryptococcosis

J Int Med Res. 2018 Jul;46(7):2687-2695. doi: 10.1177/0300060518769541. Epub 2018 May 30.

Abstract

Objective Diagnosis of pulmonary cryptococcosis is difficult. In this study, we examined the clinical and radiological features that increase the diagnostic accuracy for pulmonary cryptococcosis. Methods This retrospective study included clinical data from 68 patients with pulmonary cryptococcosis from 2012 to 2016 in 3 tertiary hospitals. Results Among the 68 patients, 39 (57.35%) had no complications, 39 (57.35%) had clinical symptoms, 6 (8.82%) had a history of occupational exposure, 27 (39.71%) had a single nodule/mass (the most common type of pulmonary cryptococcosis) on chest computed tomography images, 21 (30.88%) had multiple nodules/masses, 16 (23.53%) had ground glass opacity with or without nodules, 2 (2.94%) had miliary nodules, and 2 (2.94%) had enlarged mediastinal lymph nodes. Fifty-three (77.94%) patients had lesions with irregular margins, 33 (48.53%) had spiculated lesions, 32 (47.06%) had air bronchograms, 9 (13.24%) had cavities, and 4 (5.88%) had calcifications. Twenty-four patients underwent surgery, 35 received antifungal treatment, and 9 received both treatments. Conclusion The clinical features and computed tomography signs found in this study are not specific for a diagnosis of pulmonary cryptococcosis. Therefore, an increased awareness of pulmonary cryptococcosis is needed among clinicians.

Keywords: Pulmonary cryptococcosis; chest computed tomography; enlarged mediastinal lymph nodes; miliary nodules; multiple nodules/masses; single nodule/mass.

MeSH terms

  • Adolescent
  • Adult
  • Antifungal Agents / therapeutic use
  • Biopsy
  • Child
  • Child, Preschool
  • Cryptococcosis / diagnosis*
  • Cryptococcosis / diagnostic imaging
  • Cryptococcosis / pathology
  • Cryptococcosis / therapy
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Lung / diagnostic imaging*
  • Lung / drug effects
  • Lung / pathology
  • Lung / surgery
  • Lung Diseases, Fungal / diagnosis*
  • Lung Diseases, Fungal / diagnostic imaging
  • Lung Diseases, Fungal / pathology
  • Lung Diseases, Fungal / therapy
  • Male
  • Middle Aged
  • Pneumonectomy
  • Retrospective Studies
  • Tomography, X-Ray Computed
  • Young Adult

Substances

  • Antifungal Agents