High-Resolution CT Findings of 77 Patients with Untreated Pulmonary Paracoccidioidomycosis

Abstract

The high-resolution CT findings of patients with pulmonary PCM who have not yet been treated consist of ground-glass attenuation areas associated with small centrilobular nodules, cavitated nodules, large nodules, parenchymal bands, and areas of cicatricial emphysema. These abnormalities are usually distributed in the posterior and peripheral regions of the lungs, with discrete predominance in the middle lung zones.

Un caso excepcional de paracoccidioidomicosis e histoplasmosis pulmonares de presentación concomitante

“…(5) In the present case, radiological lung involvement was extensive, showing interstitial nodular pattern, fibrosis, and cavities, all of which have often been described in paracoccidioidomycosis (6)(7)(8) and in histoplasmosis. Mediastinal nodal involvement can lead to necrosis, (9) and this is due to paracoccidioidomycosis, given that chronic cavitary histoplasmosis does not usually cause mediastinal adenopathy.…”

Pulmonary Paracoccidioidomycosis: Clinical, Immunological and Histopathological Aspects

“…The most frequent HRCT findings in patients with pulmonary PCM were ground-glass attenuation areas; small centrilobular, cavitated and large nodules; parenchymal bands; airspace consolidations; interlobular septal thickening; architectural distortion; traction bronchiectasis; paracicatricial emphysema and fibrosis. Most of those HRCT findings concentrated in the periphery and posterior regions involving all lung zones, with slight increased intensity in the middle zones (Funari et al, 1999;Marchiori et al, 2008Marchiori et al, , 2009Muniz et al, 2002;Souza et al, 2006). The radiologic patterns described above in patients with pulmonary PCM were dependent on the stage of the disease and on the exclusion or inclusion of patients who had received previous treatment were excluded.…”

“…In regards to fibrotic findings on chest tomography, this process has been described as thickening of interlobular and alveolar septa, primarily those interconnecting the granulomas (Marchiori et al, 2011). This has been correlated histopathologically with prominent collagen deposition, especially near the hilar regions, comprising lymph nodes, bronchi and the main pulmonary artery branches; additionally, pulmonary architectural alterations were also observed (Funari et al, 1999;Marchiori et al, 2011;Souza et al, 2006).…”

Which is your diagnosis?

“…The most affected endemic areas in the world are located in subtropical regions of Brazil, and the infection is particularly prevalent amongst rural workers. Although most of cases occur in developing countries, recent immigration patterns and the increase in international travels have led to an increasing number of cases of PCM in the United States of America and Europe (1)(2)(3)(4)(5)(6)(7)(8) . PCM is caused by the dimorphic fungus Paracoccidioides brasiliensis.…”

“…Lungs constitute the main targets organs of the P. brasiliensis and chronic alterations are responsible for the associated morbidity and mortality. The disease is generally asymptomatic, but may progress to severe lung involvement, leading to progressive cough and dyspnea (1)(2)(3)(4)(5)(6)(7)(8) . The initial lesion is similar to that of the primary tuberculosis complex, and is either controlled by natural defense mechanisms or progresses to symptomatic disease.…”