Criptococose pulmonar: aspectos na tomografia computadorizada

Abstract

A criptococose pulmonar é uma doença causada pelo Criptococcus neoformans, um fungo unimórfico que possui distribuição mundial, existindo na mesma forma tanto no seu habitat natural quanto em animais e humanos. A doença possui apresentações clínica e patológica variáveis e pode manifestar-se tanto em pacientes com a imunidade normal como em imunocomprometidos, que representam a maioria dos casos. Neste trabalho são analisados os aspectos encontrados nas tomografias computadorizadas do tórax de 14 pacientes com criptococose pulmonar confirmada. Os achados mais freqüentes na tomografia do tórax foram as massas e os nódulos pulmonares. Outros aspectos observados foram as áreas de escavação, as consolidações, o espessamento do interstício peribroncovascular e o reticulado difuso. Massa pulmonar foi o achado isolado mais comum (64,2%), seguido dos nódulos isolados ou múltiplos (35,7%). Doença pulmonar difusa foi vista em apenas 14,2% dos casos. Os lobos superiores foram os mais comprometidos, sendo a doença mais comum nas regiões anteriores. A tomografia do tórax permitiu avaliar com precisão o grau de comprometimento do parênquima pulmonar. Unitermos: Radiologia; Criptococose pulmonar; Tomografia computadorizada.Pulmonary cryptococcosis: computed tomography findings. Pulmonary cryptococcosis is caused by Cryptococcus neoformans, a world-wide distribution unimorphic fungus that exhibits the same form in its natural habitat, animals and humans. The disease presents variable clinical and pathologic features and occurs in immunocompetent and immunocompromised patients. We reviewed the computed tomography findings of 14 patients with confirmed pulmonary cryptococcosis. The most frequent computed tomography findings were masses and pulmonary nodules. Other abnormalities included cavities, areas of consolidation, peribronchovascular interstitial thickening and diffuse linear opacities. Pulmonary masses were the most frequent findings (64.2%), followed by nodules (35.7%) whereas diffuse pulmonary disease accounted for 14.2% of the cases. The most affected areas were the upper lobes and the anterior regions. Computed tomography scan of the chest allows a precise assessment of pulmonary parenchymal involvement in patients with pulmonary cryptococcosis. simples, nódulos múltiplos que evoluem para confluência ou escavação, consolidação segmentar, broncopneumonia bilateral ou padrão misto, derrame pleural e linfonodomegalias. Os pacientes com integridade da imunidade apresentam maior tendência à formação de nódulo, sem predileção lobar (7) . Neste trabalho foi realizado um estudo retrospectivo a partir das tomografias computadorizadas de tórax de 14 pacientes, provenientes de várias instituições médi-cas, objetivando demonstrar os aspectos tomográficos da criptococose pulmonar. A tomografia computadorizada representa uma importante etapa no diagnóstico desta doença, pois a partir deste exame é possível estabelecer uma correlação anátomo-clínica, evidenciar o grau de acometimento do parênquima pulmonar, a extensão da infecção (pl...

Pulmonary cryptococcosis in an immunocompetent patient—A case report

“…Immunocompetent individuals, such as the patient in question, present with nodular lesions or masses [1,4]. Other cases of immunocompetent patients reported in the literature showed the same image aspect, however, clinical history was variable [4,6,7]. This report reinforces the importance of pseudotumoral lesions for the differential diagnosis of lung masses by radiologists, pulmonologists and oncologists.…”

“…A less common finding is excavation. Immunocompetent individuals, such as the patient in question, present with nodular lesions or masses [1,4]. Other cases of immunocompetent patients reported in the literature showed the same image aspect, however, clinical history was variable [4,6,7].…”

Criptococose pulmonar isolada em paciente imunocompetente

“…Empyema, pneumothorax and pleural involvement suggestive of Pancoast tumor, (13) as well as lung masses invading the chest wall, (14) have also been reported in the literature. A computed tomography scan of the chest corroborates the radiological findings, providing better details for the differential diagnosis, (11) and, when necessary, helps program the invasive diagnostic techniques. In the present case, the patient presented a lung mass that mimicked neoplasia.…”

“…Symptomatic patients can present symptoms of infection, such as fever, cough, chest pain, weight loss and purulent sputum. (1,5,9,(11)(12) Some authors reported that 24 (67%) of 42 cases as symptomatic, showing respiratory and/or constitutional symptoms such as cough, dyspnea, fever, night sweats and hemoptysis. (1) The authors of that study also highlighted the fact that, in immunocompromised patients, cryptococcosis can be severe and rapidly progressive, requiring prolonged antifungal treatment.…”

Pulmonary tuberculosis presenting with aortic pseudoaneurysm, diffuse alveolar hemorrhage, and cardiomyopathy: Is there an intriguing relationship?

“…So far, TB as the cause of pseudoaneurysm has been only occasionally reported, with less than 50 cases since 1945 in the literature in English [1,[3][4][5][6][7]. Typical clinical scenarios of tuberculous aortic pseudoaneurysm include evidence of TB infection elsewhere in the body, with 1 or more of 3 presentations: fever and persistent pain related to the location of the pseudoaneurysm, dysphagia, or hoarseness; evidence of massive bleeding; or pulsative, rapidly expanding para-aortic mass [1].…”