Title:CT and CT-guided Percutaneous Needle Biopsy in Diagnosis of Primary Pulmonary Cryptococcosis in Immunocompetent Patients
VOLUME: 13 ISSUE: 1
Author(s):Jibo Hu, Hongjie Hu, Susu Xie, Xiaoming Yang, Yaoying Zhong and Yijie Shi
Affiliation:Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016
Keywords:Pulmonary cryptococcosis, Immunocompetent, CT imagings, CT guided biopsy, Diagnosis.
Abstract:Objective: Primary pulmonary cryptococcosis in immunocompetent patients is very easily
misdiagnosed or even missed. Accurate diagnosis of this disease is critical for a timely and proper
treatment. This study aims to address the importance of computed tomography (CT) and CT-guided
percutaneous needle biopsy for primary pulmonary cryptococcosis in immunocompetent patients.
Methods: We retrospectively analyzed clinical features and CT findings of 36 immunocompetent patients
with pathologically confirmed primary pulmonary cryptococcosis. CT-guided percutaneous
pulmonary needle biopsies were performed in 25 of these patients.
Results: Nineteen patients were symptomatic, including cough, chest pain, expectoration, bloody
sputum or hemoptysis, and fatigue. Seventeen patients were asymptomatic. CT examinations displayed
a single-lobe lesion in 29 cases and multiple-lobe lesions in 7 cases. Lesions were located in
the outer zone in 33 cases, and in the middle zone in 3 cases. CT findings were primarily classified
into 2 types: solitary nodule (10 cases, 27.8%) and localized multiple miscellaneous nodule or consolidation
(26 cases, 72.2%). In addition, air-bronchograms within the lesions, irregular cavitations
and halo signs were found in 21, 8 and 10 cases, respectively. Twenty two (88%) of 25 CT-guided
percutaneous pulmonary needle biopsies were confirmed to be pulmonary cryptococcosisby
pathology.
Conclusions: CT findings of localized multiplemiscellaneous nodules or consolidations with airbronchograms,
or cavitations, or halo signs, strongly support the presence of primary pulmonary
cryptococcosis. CT-guided percutaneous needle biopsy helps with the accurate diagnosis of this disease.
