Fig 5 - uploaded by Edson Marchiori
Content may be subject to copyright.
High-resolution CT scan at inferior pulmonary veins shows multifocal ground-glass attenuation areas, nodules with halo sign, and " reversed halo sign " at left lung in 55-year-old man with pulmonary paracoccidioidomycosis.
Source publication
The objective of our study was to describe the high-resolution CT findings of 77 patients with pulmonary paracoccidioidomycosis (PCM) who had not yet been treated for PCM.
The high-resolution CT scans of 77 consecutive patients with proven pulmonary PCM were reviewed by two chest radiologists, and decisions regarding the CT findings were reached by...
Similar publications
The purpose of this study was to identify characteristic radiographic findings in children with pulmonary blastomycosis.
We reviewed the charts and radiographs of 18 children with culture-proven acute pulmonary blastomycosis. The 10 boys and eight girls were from 1 to 16 years old. Sixteen were Native Canadian Indians, and two were white. All avail...
To assess the pulmonary parenchymal findings on high-resolution CT in 41 patients with the chronic form of paracoccidioidomycosis (South American blastomycosis).
The study included 41 consecutive patients in whom chronic paracoccidioidomycosis had been proven. All patients underwent high-resolution CT (1-mm collimation, high-spatial-frequency recon...
Citations
... Bronchial wall thickening, nodules, cavitary nodules, cavities, pleural thickening, and parenchymatous bands have also been frequently reported [131,132]. These abnormalities are usually distributed in the posterior and peripheral regions of the lungs, with discrete predominance in the middle lung zone [133]. After treatment, signs of residual fibrosis persist in at least 30-40% of patients, such as architectural distortion (90%), reticulate and septal thickening (88%), centrilobular and paraseptal emphysema (84%), and parenchymal bands (74%) [118,124,134]. ...
Coccidioidomycosis (CM) and paracoccidioidomycosis (PCM) are systemic mycoses that are highly endemic in Latin America and have recently been included on the World Health Organization (WHO) Fungal Priority Pathogens List. Coccidioides immitis and Coccidioides posadasii are recognized as etiological agents of CM, with peculiarities in their geographic distribution. The genus Paracoccidioides now includes Paracoccidioides lutzii and the Paracoccidioides brasiliensis complex, which encompasses four phylogenetic species. In both diseases, pulmonary signs and symptoms are the main reasons for patients to seek medical assistance, and they are frequently misdiagnosed as tuberculosis. In this paper, we present a critical view of the strategies for diagnosis and clinical management of CM and PCM. Over the past few decades, there has been an increase in the number of reports of endemic fungal infections in areas previously thought to be “non-endemic” due to climate change and increased travel, among other factors. Learning to recognize their main epidemiological aspects and clinical manifestations is crucial so that clinicians can include them in the differential diagnosis of lung disease and avoid late diagnosis.
... Pulmonary involvement in PCM patients has been evaluated according to several aspects -clinical [3][4][5][6][7], radiographic [3][4][5][7][8][9], function tests [10][11][12] tomographic [6,7,9,[12][13][14][15][16], tomographic-pathologic correlation [17], the six-minute walk test [12], health-related quality of life questionnaires [12], residual lesions [8,12,18], and quantification of fibrosis and emphysema [18]. Nevertheless, these studies have not presented a radiographic and/or tomographic severity classification specific for PCM. ...
Abstract The lungs have great importance in patients with paracoccidioidomycosis since they are the portal of entry for the infecting fungi, the site of quiescent foci, and one of the most frequently affected organs. Although they have been the subject of many studies with different approaches, the severity classification of the pulmonary involvement, using imaging procedures, has not been carried out yet. This study aimed to classify the active and the residual pulmonary damage using radiographic and tomographic evaluations, according to the area involved and types of lesions.
... In the chronic stage of the disease, which is more common, the most frequent CT findings include pulmonary opacities with ground-glass attenuation (60%), nodules (50%), cavitation (40%), parenchymal scarring and fibrosis (30%), and areas of cicatricial emphysema (30%-50%), often in a predominant peripheral and posterior distribution affecting all lung zones (Fig. 14). 75,76 The reverse halo sign (central ground-glass opacity surrounded by denser air-space consolidation in a crescent or ring shape) has also been reported in pulmonary PCM, but is a nonspecific imaging finding that can be seen in several infectious and noninfectious pulmonary pathologies. 77 In the long term, up to 25% of infected patients may develop precapillary pulmonary hypertension, even after declared free of the infection after appropriate antimycotic therapy. ...
Infectious diseases, including parasitic diseases, which are commonly associated with poverty and poor sanitation, continue to cause significant morbidity, disability, and mortality in Latin America and the Caribbean region. This article reviews the epidemiology, pathophysiology, and cardiothoracic imaging manifestation of several communicable diseases endemic to this region.
... The use of cavity wall thickness to discriminate among infectious etiologies of pulmonary cavities is even more problematic. While some infections, such as pneumocystis pneumonia, coccidioidomycosis, and echinococcus, have been classically associated with thin walled cavities, the absence of comparative studies with systematic and objective measurements of cavity wall thickness among infectious etiologies severely limits the use of cavity wall thickness as a diagnostic tool in discriminating among infectious causes of cavities 20 . This study had many clinical advantages regarding describing the role of CT scan in solitary pulmonary cavitary lesion and the detection of important role of discordance on CT scan, diameter and thickness of pulmonary cavities in facilitating the diagnosis of malignancy in earlier time which help in earlier management and saving lives. ...
... The findings are usually bilateral and symmetrical, with periphery and posterior involvement, with a slight predominance in the middle region of the lungs. 78,94,95 Pulmonary involvement is marked by the association of multiple nonspecific findings on chest CT, including ground-glass opacities, nodules or masses, consolidations, cavitation, interlobular septal thickening, and fibrotic lesions (►Figs. 3 and 4). ...
... 94 This observation correlated with the study by Souza et al, which demonstrated that ground-glass opacities were the most common abnormalities in CT of patients with untreated PCM (58.4%). 95 The filling of alveolar spaces by inflammatory exudate leads to the formation of nodules of various sizes. The nodular pattern can be defined as macronodular or miliary. ...
... 94 In Souza et al's study, in untreated patients, small centrilobular nodules were present in 45.5%, cavitary nodules in 42.9%, and large nodules in 41.6%. 95 Airspaces may fill and lead to consolidation, known as the pneumonic form of the disease; this occurs when fungus is found in abundance, and cavities may also occur. It was Fig. 3 Axial computed tomography (CT) images of patients with chronic paracoccidioidomycosis. ...
Paracoccidioidomycosis (PCM) is one of the most relevant systemic endemic mycoses in Latin American countries, especially in South American countries, with endemic and hyperendemic areas. The real burden of PCM may be underestimated because of a lack of compulsory case notification. Recent phylogenetic data revealed that Paracoccidioides brasiliensis comprises several cryptic species including P. brasiliensis and P. lutzii. However, the genetic biodiversity of Paracoccidioides does not affect the clinical manifestations or therapeutic response to therapy. Lung involvement is a common finding, especially in patients experiencing the chronic form of the disease, and, because of its similarities with tuberculosis, clinicians must be alert to the possibility of PCM in patients with chronic respiratory manifestations and epidemiological risk factors for this fungal disease.
... Como achado acessório descreve-se, ainda, a possibilidade de associação do vidro fosco a consolidações -mais frequente em indivíduos sem infecção pelo HIV -e cistos (17) . Opacidades em vidro fosco são o achado mais frequente nos pacientes com paracoccidioidomicose sem tratamento, comumente de distribuição esparsa (19) . Refletem espessamento intersticial intralobular por inflamação, com ou sem preenchimento do espaço aéreo, ou podem resultar, ainda, de fibrose intralobular (20) . ...
... Nódulos móveis no interior de escavação pulmonar também são característicos na apresentação saprofítica da aspergilose (23) . Nódulos e nódulos escavados, bem como opacidades nodulares centrolobulares, são padrões frequentes na paracoccidioidomicose sem tratamento, achados que mais frequentemente predominam nos campos pulmonares periféricos, posteriores e com pequeno predomínio nos campos pulmonares médios (Figura 3) (19) . ...
Pulmonary fungal infections, which can be opportunistic or endemic, lead to considerable morbidity and mortality. Such infections
have multiple clinical presentations and imaging patterns, overlapping with those of various other diseases, complicating the diagnos-
tic approach. Given the immensity of Brazil, knowledge of the epidemiological context of pulmonary fungal infections in the various
regions of the country is paramount when considering their differential diagnoses. In addition, defining the patient immunological
status will facilitate the identification of opportunistic infections, such as those occurring in patients with AIDS or febrile neutropenia.
Histoplasmosis, coccidioidomycosis, and paracoccidioidomycosis usually affect immunocompetent patients, whereas aspergillosis,
candidiasis, cryptococcosis, and pneumocystosis tend to affect those who are immunocompromised. Ground-glass opacities, nod-
ules, consolidations, a miliary pattern, cavitary lesions, the halo sign/reversed halo sign, and bronchiectasis are typical imaging
patterns in the lungs and will be described individually, as will less common lesions such as pleural effusion, mediastinal lesions,
pleural effusion, and chest wall involvement. Interpreting such tomographic patterns/signs on computed tomography scans together
with the patient immunological status and epidemiological context can facilitate the differential diagnosis by narrowing the options.
... 42e44 Paracoccidioidomycosis, in particular, has been associated with a high frequency of cavitation and the "reverse halo sign" (in the absence of organizing pneumonia) with other MDCT features including traction bronchiectasis and paracicatricial emphysema. 45,46 Infrequent fungal cavitating pneumonias include Penicillium marneffei. 2 Pneumocystis jirovecii is classified as a fungus, and although most commonly associated with HIV infection, solid-organ and bone-marrow transplant recipients are also at risk of pneumonia. ...
Pulmonary syndromes following exposure to Aspergillus sp. have a variety of clinical and radiological manifestations. The radiological manifestations mirror the pathophysiological response to Aspergillus sp., which is linked closely to the patient's immune status. The plethora of terms in the literature can be confusing and their application with relevance to radiological imaging may subsequently result in inadequate or non-specific classification. In this review, we aim to provide a simplified and up-to-date approach to the recognition of the imaging manifestations of pulmonary aspergillosis, using correlation with histopathological and clinical descriptors. This will enable the radiologist to utilise the imaging findings to instigate clinically useful and appropriate management for those patients at risk of significant morbidity and mortality.
... The use of cavity wall thickness to discriminate among infectious etiologies of pulmonary cavities is even more problematic. While some infections, such as pneumocystis pneumonia, coccidioidomycosis, and echinococcus, have been classically associated with thin walled cavities, the absence of comparative studies with systematic and objective measurements of cavity wall thickness among infectious etiologies severely limits the use of cavity wall thickness as a diagnostic tool in discriminating among infectious causes of cavities 20 . This study had many clinical advantages regarding describing the role of CT scan in solitary pulmonary cavitary lesion and the detection of important role of discordance on CT scan, diameter and thickness of pulmonary cavities in facilitating the diagnosis of malignancy in earlier time which help in earlier management and saving lives. ...
DIAMETER, THICKNESS AND DISCORDANCE DEGREE OF SOLITARY PULMONARY CAVITARY LESION TO DIFFERENTIATE BENIGN FROM MALIGNANT LESIONS, A MUTLISLICE CT STUDY.
Ammar Mosa Jawad *, Mohammed Abd kadhim# & Husham Jubran Mousa@ *MB,ChB, Radiologist in The Medical Collage, Al-Nahrain University. #MB,ChB, FIBMS, Radiologist, Professor in The Medical Collage, Al-Nahrain University, Consultant Radiologist in Al-Imamain AlKadhimain Medical City, Baghdad Iraq. @MB,ChB, FIBMS, Specialist Radiologist in Al-Sader Teaching hospital, Basrah, IRAQ.
Absctract Cavities are frequent image findings in a variety of pulmonary diseases including both lung
cancer and pulmonary tuberculosis, Computed Tomography (CT) is accepted as the modality of choice for detection of possible cavitating pulmonary nodules. The aim of this study is to assess the role of diameter, thickness and discordance degree of solitary pulmonary cavitary lesion to differentiate benign from malignant lesions in multislice CT. This cross sectional study was done in the Computed Tomography Unit of Al-Imamain Al
Kadhimain Medical City, Baghdad, Iraq and Al-Sader Teaching Hospital, Basrah,
Iraq between October 2016 and June 2017. All patients are with solitary pulmonary cavitary lesions detected by chest x-ray referred for different reasons. Exclusion criteria included: multiple cavitary lung lesions, patients with known lung carcinoma or pulmonary tuberculosis on treatment, and patients receiving chest radiotherapy for different reasons. CT examination of the chest was
performed by multi-detector CT (Somatom definition edge, SIEMENS (256 slices)) with 2 sets of CT examination one before and another after giving IV nonionic iodinated contrast medium (Ultravist 370 mg /ml), 1.5 ml/kg Body weight. The final diagnosis was obtained depending on the sputum culture for AFB, bronchoscopy and biopsy, bronchoscopy and brush cytology and true cut biopsy. Eighty percent of the patients were diagnosed as having benign lesions and 20% were diagnosed as having malignant lesions, the most frequent diagnosis was TB (60%), followed by squamous cell carcinoma (14%), lung abscess (10%), hydatid cyst (10%), adenocarcinoma (4%), and metastasis (2%). The discordance of CT scan (FDCW3) show highly significant association with malignant solitary cavitary lesions, while CT concordance
(FCCW1 and FCCW2) were significantly associated with benign solitary cavitary lesions (p
... PCM is often seen in farm workers, with the highest incidence occurring between the ages of 25 to 60 (5). Development of the disease can occur several years after initial infection (6). The authors present a case of pulmonary PCM with lung lesion. ...
Introduction: Paracoccidioidomycosis (PCM) is a type of mycosis most often found in the lung. The authors present a case of pulmonary PCM. Case Presentation: A-72-year-old man had a four-year history of dyspnea, dry cough, and weakness and a recent weight loss of more than 10 kg. First, he was treated with glucocorticoid, but he did not continue this treatment. Core needle biopsy was done. Pathology reported paracoccidioidomycosis. The patient was treated with itraconazole. Conclusions: PCM has not been reported in Iran until now, but it should be considered as a differential diagnosis when risk factors or symptoms of PCM are detected.
... It is the most frequent endemic systemic mycosis in Latin America, particularly in Brazil, Venezuela, Colombia and Argentina. 1 Several cases of PCM have also been reported in Europe and North America, mainly among immigrants and travellers. 2 The disease predominantly affects males between the ages of 30 and 60 years from rural areas and is only transmitted from contact with contaminated soil, the fungus habitat. 3 Inhalation of infectious particles develops into primary infection that may progress to severe pulmonary involvement. ...
The purpose of this study was to identify morphological characteristics of the reversed halo sign (RHS) on chest computed tomography (CT) in patients with pulmonary paracoccidioidomycosis (PCM) that may aid the diagnosis of this fungal disease.
We retrospectively reviewed chest CT images from 23 patients with proven pulmonary PCM who demonstrated the RHS. Two chest radiologists analyzed the morphological characteristics of the lesions and reached decisions by consensus.
We identified 64 RHSs on CT images from the 23 patients. Multiple lesions were observed in all cases, with middle and lower lung zone predominance occurring in 73.9% of cases. Thirty-four (53.1%) RHSs were round and 30 (46.9%) were oval. Outer borders of the RHSs were smooth in 32 (50%) lesions, nodular in 16 (25%), and irregular/spiculated in 16 (25%) lesions. Ground-glass opacity was observed inside 63 (98.4%) lesions.
Our data suggest that morphological characteristics of the RHS on chest CT, such as the presence of multiple lesions, middle and lower lung zone predominance, and a spiculated RHS ring, as well as the association with other parenchymal patterns, should lead radiologists to include PCM in the differential diagnosis of PCM in endemic areas. Advances in knowledge: This is the largest series of patients with RHS due to PCM, and is also the first study to report RHS lesions with spiculated or irregular walls. The study adds information regarding morphologic characteristics of the RHS that may raise suspicion of PCM on chest CT, particularly in endemic areas of the disease.
