Acute pulmonary coccidioidomycosis: CT findings from 15 patients.

The aim of this study was to describe the CT scan abnormalities in 15 patients with acute pulmonary coccidioidomycosis. Retrospective analysis of chest CT scans from 15 patients with acute pulmonary coccidioidomycosis was performed. The final diagnosis included the finding of Coccidioides immitis in mycology and/or histopathology, complemented by serology. Two radiologists evaluated the CT scans to study the type, size, profusion and localization of the findings. The final decisions were defined by consensus. CT scans showed multiple bilateral nodules in 13 patients and solitary nodules associated with consolidation in 2 cases. The nodules had ill-defined contours, ranging from 0.5 cm to 3.0 cm in diameter, which were predominant in the lower lobes in 11 cases. Cavitation of nodules was observed in 13 cases and coalescence in 7. Nodule-associated abnormalities were found in 13 cases, comprising interlobular septal thickening (n = 7) and consolidations (n = 6). Other abnormalities included lymph node enlargement (n = 6) and small pleural effusion (n = 2). In conclusion, the main CT finding in patients with acute coccidioidomycosis was that of multiple nodules (0.5-3.0 cm) at the lungs bases; a significant proportion of the remaining cases also showed other abnormalities. A diagnosis of coccidioidomycosis must be considered in patients with multiple lung nodules that are either in, or have recently been transported to, areas of endemic mycosis.

Pulmonary and cardiac cysticercosis: helical CT findings.

The authors aim to report the chest CT findings of a patient with disseminated cysticercosis, emphasising the pulmonary and cardiac features. The main finding consisted of multiple pulmonary, cardiac and chest wall nodules. The present case demonstrates that cysticercosis should be considered in the differential diagnosis of multiple pulmonary nodules, mainly in those patients with similar lesions in the cardiac muscle and/or in the chest wall.

Stenotrophomonas maltophilia pneumonia after bone marrow transplantation: case report with emphasis on the high-resolution CT findings.

A 6-year-old female patient who underwent bone marrow transplantation because of Fanconi anaemia presented with fever, dyspnoea and cough 17 days after the procedure. The physical examination revealed diffuse crackles. Chest radiographs demonstrated diffuse alveolar opacities in both lungs. High-resolution CT showed a diffuse and bilateral lung lesion characterized by multifocal areas of air-space consolidation associated with ground-glass attenuation and small centrilobular nodules. The culture of the material obtained with bronchoalveolar lavage only demonstrated growth of Stenotrophomonas maltophilia. The patient rapidly presented respiratory insufficiency and death in the same day.

Hantavirus pulmonary syndrome: high-resolution CT findings in one patient.

Physical examination demonstrated petechiae, leg oedema and mild dyspnoea. Chest radiograph showed minimal bilateral hazy increased opacification, mainly on the right side, and small bilateral pleural effusions. High-resolution CT demonstrated extensive bilateral ground-glass opacities most severe in the middle and lower lung zones. Also noted were a few slightly thickened interlobular septa, a few poorly defined small nodules, bronchial wall thickening and small bilateral pleural effusions. Blood tests revealed high leukocyte and low platelet counts. Renal function was normal. Serological test (ELISA) for hantavirus using SNV (Sin Nombre virus) antigen was positive. The patient received supportive treatment, gradually improved, and was discharged 10 days after hospital admission. His symptoms completely resolved and follow-up radiographs returned to normal.

Rhodococcus equi pneumonia in AIDS: high-resolution CT findings in five patients.

The aim of this study was to describe the high-resolution CT scan findings in five patients with AIDS and pulmonary infection due to Rhodococcus equi. The study included five patients with AIDS and proven R. equi infection. The CT scans were reviewed by two observers. The patients included four men and one woman ranging from 39 years to 49 years in age (mean 42 years). The findings included areas of consolidation (n=5) with single (n=1) or multiple cavitation (n=4), ground-glass opacities (n=5), centrilobular nodules (n=3), small centrilobular nodular opacities (n=3) and "tree in bud" opacities (n=3). None of the patients had pleural effusion or lymph node enlargement. The most common high-resolution CT manifestations of R. equi infection consist of areas of consolidation with cavitation, ground-glass opacities, nodules and a tree-in-bud pattern.

Pulmonary alveolar microlithiasis presenting with crazy-paving pattern on high resolution CT.

Pulmonary alveolar microlithiasis (PAM) is an uncommon chronic disease characterized by calcifications within the alveoli and a paucity of symptoms in contrast to the imaging findings. We present a 59-year-old woman with a 4-year history of shortness of breath on exertion. Lung auscultation revealed random wheezes and fine and coarse crackles. Pulmonary function tests showed a restrictive pattern. The chest radiograph demonstrated a bilateral symmetric micronodular pattern. High resolution CT scan revealed diffuse ground-glass attenuation with superimposed septal thickening ("crazy-paving" pattern). The patient underwent a lung biopsy, which confirmed the diagnosis of PAM. Our case demonstrates that PAM needs to be considerate in the differential diagnosis of lung lesions that present with crazy-paving pattern on the high resolution CT.