title: High-resolution CT findings of patients with pulmonary nocardiosis.
abstract: BACKGROUND
  Opportunistic pulmonary infection with Nocardia species is rare in humans, and only a few studies have radiologically analyzed patients with pulmonary nocardiosis using high-resolution computed tomography (HRCT).
  
  
  METHODS
  We retrospectively reviewed the medical records of patients with pulmonary nocardiosis at our hospital between April 2006 and December 2011 to assess HRCT and clinical findings. We also searched the medical literature for pulmonary nocardiosis reported in Japan between 2002 and 2011 for comparison.
  
  
  RESULTS
  We identified seven patients at our institution and 33 reported infections in Japan. Four of our patients were immunocompetent, whereas the other three had impaired cellular immunity due to type 2 diabetes mellitus or having been inappropriately treated with steroid. Thoracic HRCT revealed no zonal predominance, but tropism for distribution from the middle to the peripheral area, and radiological findings of nodules, cavitation, mass, consolidations, bronchial wall thickening, septal line thickening and ground glass opacity (GGO) were evident. The main HRCT finding in our study comprised nodules (n=5, 71.4%) <30 mm and four patients had multiple nodules as described in other reports. Furthermore, we discovered a crazy paving appearance (CPA) around nodules, cavities, masses or consolidations in five patients (71.4%).
  
  
  CONCLUSIONS
  Multiple nodules distributed from the middle to the peripheral area on HRCT might reflect pulmonary nocardiosis, and CPA seemed to be a worth paying attention to the diagnosis.
authors.affiliation: Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka, Tokyo, Japan;
authors.forename: Naoki
authors.initials: N
authors.lastname: Tsujimoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Saraya
authors.forename: Ken
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Saori
authors.initials: S
authors.lastname: Takata
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kurihara
authors.forename: Sayuki
authors.initials: S
authors.lastname: Hiraoka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Makino
authors.forename: Shota
authors.initials: S
authors.lastname: Yonetani
authors.forename: Koji
authors.initials: K
authors.lastname: Araki
authors.forename: Haruyuki
authors.initials: H
authors.lastname: Ishii
authors.forename: Hajime
authors.initials: H
authors.lastname: Takizawa
authors.forename: Hajime
authors.initials: H
authors.lastname: Goto