Chest ImagingFungal infection, pulmonary
These infections can be divided into those that occur in generally healthy individuals and those that occur opportunistically in immunosuppressed patients. In the first group organisms such as
Histoplasma capsulatum,
Coccidioides immitis and
Blastomyces dermatitidis are frequent pathogens in certain endemic regions of the western hemisphere. Usually these fungi produce minimal nonpulmonary disease but occasionally pneumonia is observed and rarely dissemination may be fatal. In some instances the primary pneumonias caused by these fungi simulate ordinary bacterial pneumonia and may be overlooked as the aetiology of a patient's illness.
Fungi which affect immunosuppressed individuals are frequently species of Aspergillus and Candida as well as Cryptococcus neoformans and fungi of the order Mucorales. In patients with limited defence mechanisms these organisms can produce widespread systemic disease leading to death. In the lungs a variety of abnormalities are reported but usually evidence of widespread parenchymal involvement (Fig.1) frequently with necrosis and cavitation is observed. A fungal aetiology should always be considered in immunosuppressed patients with chest film abnormalities. Diagnosis may require invasive sampling of lung parenchyma.
PGO
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A PA chest film demonstrates multiple poorly marginated nodular opacities in the lungs. These abnormalities appeared in a patient who was immunosuppressed. Disseminated fungal infection should be suspected with this history and radiographic appearance. Aspergillosis was diagnosed.
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Fungal infection, pulmonary, Fig.1 | |