title: Fungal infection mimicking pulmonary malignancy: clinical and radiological characteristics.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the clinical and radiological features of patients with fungal infection mimicking thoracic malignancy and to establish a diagnostic approach for both clinicians and radiologists to avoid misdiagnosis.
  
  
  METHODS
  In this retrospective study, we reviewed clinical and computed tomography (CT) findings from 27 patients who presented with suspicion of thoracic malignancy who were ultimately diagnosed with fungal disease.
  
  
  RESULTS
  Patients' median age was 55.7 (range 31-78) years. The most common clinical findings were cough (48.1 %), expectoration (33.3 %), chest pain (25.9 %), weakness (25.9 %), weight loss (18.5 %), and hemoptysis, dyspnea, and fever (7.4 % each). The median lesion size was 35.5 (range 10-85) mm. CT findings included a solid nodule (51.9 %), solid mass (37 %), or both (11.1 %). Nodule and mass margins were lobulated in 9 (33.3 %) patients, ill-defined in 5 (18.5 %), spiculated in 4 (14.8 %), and smooth in 4 (14.8 %) patients. Additional findings included consolidation in 4 (14.8 %) patients, cavitation in 3 (11.1 %), pleural effusion in 2 (7.4 %), and lymphadenopathy in 11 (40.7 %) patients. In all patients, specific diagnoses were made and confirmed by histopathology; final diagnoses were histoplasmosis (25.9 %), coccidiomycosis (22.2 %), cryptococcosis (22.2 %), aspergillosis (14.8 %), North American blastomycosis (7.4 %), mucormycosis (3.75 %), and paracoccidioidomycosis (3.75 %).
  
  
  CONCLUSIONS
  Fungal infection can present with clinical and radiological features that are indistinguishable from thoracic malignancy, such as lung nodules or masses. Because the management and outcomes of fungal infection and malignancy are entirely distinct, the establishment of a specific diagnosis is critical to provide appropriate therapy.
authors.affiliation: Department of Imaging, AC Camargo Cancer Center, Rua Paulo Orozimbo, 726, Aclimação, São Paulo, SP, 01535-001, Brazil, marcosduarte500@gmail.com.
authors.forename: Marcos Duarte
authors.initials: MD
authors.lastname: Guimarães
authors.forename: Edson
authors.initials: E
authors.lastname: Marchiori
authors.forename: Gustavo de Souza Portes
authors.initials: GS
authors.lastname: Meirelles
authors.forename: Bruno
authors.initials: B
authors.lastname: Hochhegger
authors.forename: Pablo Rydz Pinheiro
authors.initials: PR
authors.lastname: Santana
authors.forename: Jefferson Luiz
authors.initials: JL
authors.lastname: Gross
authors.forename: Almir Galvão Vieira
authors.initials: AG
authors.lastname: Bitencourt
authors.forename: Piyaporn
authors.initials: P
authors.lastname: Boonsirikamchai
authors.forename: Myrna Corbos Barco
authors.initials: MC
authors.lastname: Godoy
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001938:Brazil; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013781:Texas; D014057:Tomography, X-Ray Computed
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