and CT Findings Coccidioidomycosis is a fungal The hyphal form highly infectious infection caused by inhalation of spores (anthroconidia) inhalation spores (anthroconidia ) from spherules rupture endospores Coccidioides species (parasitic form) inflammation
The lungs are the target organ in Risk factors
coccidioidomycosis are involved - HIV infection in a wide spectrum of clinical - Immunosuppressive medications Imaging manifestations acute, - High-dose glucocorticoid disseminated, or chronic disease administration Diagnosis • Sputum, bronchoalveolar lavage fluid, smear from cutaneous lesions, or tissue biopsy samples. • Serologic test Enzyme-linked immunoassays immunoglobulin M and immunoglobulin G antibodies • Bronchoscopy (Bronchoscopy is a useful diagnostic procedure if sputum evaluation or serologic testing is not diagnostic) • Biopsy transbronchial lung biopsy (bronkoskopi) and percutaneous transthoracic needle biopsy with image guidance. Most biopsies are currently performed with CT guidance. Pulmonary Manifestations of Coccidioidal Infection • Acute Disease • Disseminated • Chronic forms Acute Disease (primary coccidioidal infection) Thoracic manifestations of acute coccidioidomycosis pulmonary parenchymal abnormalities, intrathoracic adenopathy, and pleural effusion. 1. Pulmonary parenchymal abnomalities consolidation, nodules, cavities, and peribronchial thickening 75% consolidation, (manifasting as) solitary or multiple areas of segmental or lobar opacification . Unilateral with perihilar and basilar. • Parenchymal opacification (varies from) a ground-glass appearance to dense homogeneous consolidation bacterial pneumonia
• A migratory pattern of parenchymal disease phantom infiltrates (in
which parenchymal consolidation) resolves at one site and reappears in a different location • 20% nodular opacities size or vary from 0.5 to 2.5 cm, often multiple and well circumscribed, in the perihilar and lower lung zones metastatic disease. • Most nodules multiple and bilateral, with ill-defined borders, and ranged between 0.5 cm and 3 cm.
• Most acute parenchymal abnormalities seen at chest radiography resolve
within 6 weeks. 2. Intrathoracic Adenopathy Adenopathy results from regional spread of infection from pulmonary parenchymal foci to hilar or mediastinal lymph nodes. Hilar or mediastial adenopathy (chest radiography) ipsilateral parenchymal consolidation, nodules, or peribronchial thickening
a. Frontal chest radiograph shows right hilar adenopathy (arrow).
b. Coronal CT image (soft-tissue window) shows extensive right hilar (white arrow) and subcarinal (black arrow) adenopathy. 3. Pleural Effusion 15%- 20% of patients with acute coccidioidomycosis Caused by contiguous spread of infection from adjacent parenchym (pengaruh penyebaran infeksi dari parenkim paru).
Frontal chest radiograph shows a small right pleural effusion (arrowhead)
Disseminated Disease Diagnosed by clinical symptoms, serologic findings, and tissue diagnosis. Imaging of Disseminated fungemia and ARDS. Coccidioidomycosis • miliary nodules caused by hematogenous spread • Parenchymal consolidation • Hilar and mediastinal adenopathy • Extrapulmonary dissemination (occurs frequently and most commonly involves the) skin, lymph nodes, bones and joints, central nervous system (vertebral disease) and hematogen. • Patients with AIDS are at increased risk of fungemia and ARDS • Diffuse or dependent lung opacities may be seen with ARDS Chronic Disease Persist beyond 6 weeks Imaging manifestations • residual nodule, • chronic cavity, • persistent pneumonia with or without adenopathy, • pleural effusion, and • regressive changes. Residual Pulmonary Nodule or Coccidioidoma Chronic Coccidioidal Cavity Differential diagnosis primary lung malignancy solitary metastasis other granulomatous infection