Clinical and Computed Tomography (CT) Characteristics of Pulmonary Nodules Caused by Cryptococcal Infection

Abstract

To investigate the clinical and computed tomography (CT) characteristics of pulmonary nodules caused by cryptococcal infection and gain a greater insight and understanding that will reduce misdiagnosis. Materials and Methods: A total of 47 patients with confirmed pulmonary cryptococcosis (PC) manifested as nodules were retrospectively enrolled from January 2013 to December 2020. The clinical and CT data of patients with single and multiple nodules were analyzed and compared with emphasis on exploring the characteristics of the solitary ones. Results: Among the 47 patients, single and multiple nodules were detected in 25 (53.2%) and 22 (46.8%) patients, respectively, with similar clinical characteristics. The diameter of solitary nodules was smaller than that of the largest ones of the multiple nodules (P = 0.000). Compared with multiple nodules, less solitary nodules were located in the subpleural zone (P = 0.031) and had a cavity or vacuole (P = 0.049). Regarding the solitary nodules, 22 (88.0%) and 3 (12.0%) were solid and subsolid, respectively. Eighteen (81.8%) solid solitary nodules exhibited either one of air bronchogram or vacuole, satellite lesions, and halo sign. Twenty-three (92.0%) of 25 patients with solitary nodules had follow-up CT data, and most of them had no changes (12, 52.1%) or increased in size and/or density (8, 34.8%), but only a few (3, 13.0%) decreased with or without anti-inflammatory therapy. Conclusion:The clinical characteristics of patients with solitary and multiple nodules caused by PC are similar. The solitary nodules are smaller, more scattered, but less necrotic than multiple ones. For solitary nodules with air bronchogram or vacuole, satellite lesions, or halo sign, PC should be considered as one of the differential diagnosis.

Pulmonary cryptococcosis mimicking lung cancer: 3 case report

“…This study suggests that most pulmonary nodules due to pulmonary cryptococcosis manifest in a more regular morphology and provide a strong reference for us to reduce the misdiagnosis rate of lung cancer. Among the three patients mentioned above, case 4 and case 2 showed single nodules on imaging, and case 3 showed multiple nodules in both lungs, all of which are consistent with the feature that pulmonary cryptococcal infections in immunocompetent patients tend to present in the nodular form [7] . Most of the features exhibited by imaging CT of nodules in the three patients in this study were lobar signs, burr signs, and pleural traction.…”

Comparison of the clinical manifestations and chest CT findings of pulmonary cryptococcosis in immunocompetent and immunocompromised patients: a systematic review and meta-analysis

“…By comparing the CT manifestations of immunocompetent and immunocompromised PC patients, we concluded the immune status results a significant impact on CT manifestations. For immunocompetent individuals with multiple nodules distributed in the lower lobes according to HRCT, PC should be taken into consideration [ 35 ]. Our results might help clinicians identifying the potential cryptococcal pneumonia and recognize the differences in clinical manifestations and CT findings in immunocompetent and immunocompromised PC patients.…”

Clinical and Computed Tomography Characteristics of Solitary Pulmonary Nodules Caused by Fungi: A Comparative Study

“…Based on the previous findings on fungal infection’s CT characteristics of fungal infection, 14–16 the cavity, vacuole sign, air crescent sign (ACS), halo sign (HS), satellite lesions, air bronchogram and lymph node enlargement were evaluated for both fungal nodules and cancerous nodules. Besides, the following CT features were also analyzed: nodule size (the mean of the longest diameter and the perpendicular diameter on axial CT images), distribution (upper, lower, or middle lobe), CT value on plain CT scan, and degree of enhancement (peak CT value on contrast-enhanced CT scan - CT value on plain CT scan).…”

“… 12 , 13 Moreover, some of the fungal nodules are stable or even grow up during follow-up. 14 Therefore, it is necessary to distinguish them for better understanding solid nodules.…”

“…However, these signs could also be found in cancerous nodules, while there was no comparative study to verify their diagnostic value for solitary pulmonary fungal nodules. 14–16 Therefore, studies regarding the differential diagnosis between fungal and cancerous nodules are lacking, and fungal nodules are still easily to be misdiagnosed due to uncertainty of clinical and CT features. The aim of this study is to reveal the differences in clinical and CT characteristics between fungal nodules and cancerous ones for better understanding the fungal nodules.…”