title: Clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment.
abstract: OBJECTIVE
  We aimed to investigate clinical and radiologic manifestations of pulmonary cryptococcosis in immunocompetent patients and their outcomes after treatment.
  
  
  METHODS
  We retrospectively reviewed the medical records, initial and follow-up chest computed tomography scans and/or radiographs for initial clinical and radiologic manifestations and outcomes following antifungal treatment of 12 immunocompetent patients diagnosed with pulmonary cryptococcosis between 1990 and 2012.
  
  
  RESULTS
  Twelve patients (age range, 21-62 years; males, eight patients [66.7%]) were included. Nine (75%) patients were symptomatic, eight of whom had disseminated infection with central nervous system involvement. Initial pulmonary abnormalities consisted of single nodules/masses (n=5), single segmental or lobar mass-like consolidation (n=3), multiple cavitary and noncavitary nodules (n=1), and multifocal consolidation plus nodules (n=3). These lesions ranged from less than 1 cm to 15 cm in greatest diameter. Distinct subpleural and lower lung predominance was observed. Seven patients (58.3%) had one or more atypical/aggressive findings, namely endobronchial obstruction (n=4), calcified (n=1) or enlarged (n=4) mediastinal/hilar lymph nodes, vascular compression (n=1), pericardial involvement (n=1), and pleural involvement (n=2). Following antifungal therapy, radiologic resolution was variable within the first six months of eight nonsurgical cases. Substantial (>75%) improvement with some residual abnormalities, bronchiectasis, cavitation, and/or fibrotic changes were frequently observed after 12-24 months of treatment (n=6).
  
  
  CONCLUSIONS
  Pulmonary cryptococcosis in immunocompetent patients frequently causes disseminated infection with atypical/aggressive radiologic findings that are gradually and/or incompletely resolved after treatment. The presence of nonenhanced low-attenuation areas within subpleural consolidation or mass and the absence of tree-in-bud appearance should raise concern for pulmonary cryptococcosis, particularly in patients presenting with meningitis.
authors.affiliation: From the Departments of Radiology (T.S. e-mail: ratrspoom@yahoo.com, W.S.), Pulmonary and Critical Care Medicine (V.B.), Infectious Diseases (S.P.W.), and Pathology (P.I.), Ramathibodi Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand; Banmi Hospital (W.S.), Lopburi Province, Thailand.
authors.forename: Thitiporn
authors.initials: T
authors.lastname: Suwatanapongched
authors.forename: Wasinan
authors.initials: W
authors.lastname: Sangsatra
authors.forename: Viboon
authors.initials: V
authors.lastname: Boonsarngsuk
authors.forename: Siriorn P
authors.initials: SP
authors.lastname: Watcharananan
authors.forename: Pimpin
authors.initials: P
authors.lastname: Incharoen
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000000981:diagnostic imaging / Q000209:etiology; D000935:Antifungal Agents / Q000627:therapeutic use; D001987:Bronchiectasis / Q000000981:diagnostic imaging / Q000209:etiology; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000209:etiology; D003453:Cryptococcosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007121:Immunocompetence; D008172:Lung Diseases, Fungal / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging / Q000209:etiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000935:Antifungal Agents