Pulmonary cryptococcosis: comparison of CT findings in immunocompetent and immunocompromised patients.
BACKGROUND
Computed tomography (CT) findings in patients with pulmonary cryptococcosis have been reported, however, many reports were limited by the small number of patients, and not taken into account the distinction between immunocompetent and immunocompromised patients.


OBJECTIVE
To retrospectively evaluate thoracic CT findings in patients with pulmonary cryptococcosis whose immune status ranged from normal to severely compromised, and determine characteristic imaging features of pulmonary cryptococcosis between patients with different immune status.


METHODS
CT scan findings of 29 immunocompetent and 43 immunocompromised patients with clinically proven pulmonary cryptococcosis were reviewed retrospectively. Different patterns of CT scan abnormalities between immunocompromised and immunocompetent patients, AIDS and non-AIDS immunocompromised patients were compared by Fisher's exact test.


RESULTS
Pulmonary nodules/masses, either solitary or multiple, were the most common CT finding, present in 65 (90.3%) of the 72 patients; associated findings included CT halo sign (n = 24), cavitation (n = 23), and air bronchogram (n = 17). Areas of consolidation (n = 14), areas of GGO (n = 13), linear opacities (n = 11), lymphadenopathy (n = 5), and pleural effusion (n = 8) were uncommon. The parenchymal abnormalities were peripherally located in 47 (65.2%) of the cases. Cavitations within nodules/masses were more frequently present in immunocompromised patients than in immunocompetent patients (P = 0.009), and in AIDS patients than in non-AIDS immunocompromised patients (P = 0.002). Air bronchograms within nodules/masses were more frequent present in immunocompetent patients than in immunocompromised patients (P = 0.005). Nodules/masses with halo sign were less frequent in AIDS patients than those in non-AIDS immunocompromised patients (P = 0.027).


CONCLUSIONS
Pulmonary cryptococcosis should be considered in the differential diagnosis of solitary or multiple pulmonary nodules. Cavitations within nodules/masses were more commonly seen in immunocompromised patients, especially AIDS patients, while air bronchograms were more commonly seen in immunocompetent patients.
Department of Nuclear Medicine, Wuhan General Hospital of CPLA Guangzhou Military Command, Wuhan, PR China xielixuan1110@163.com.
Li-xuan
LX
Xie
Department of Radiology, Wuhan General Hospital of CPLA Guangzhou Military Command, Wuhan, PR China.
You-san
YS
Chen
Department of Radiology, Shanghai Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, PR China.
Shi-yuan
SY
Liu
Department of Radiology, Public Health Clinical Center Affiliated to Fudan University, Shanghai, PR China.
Yu-xin
YX
Shi
D000293:Adolescent; D000328:Adult; D000368:Aged; D003453:Cryptococcosis / Q000000981:diagnostic imaging* / Q000276:immunology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007121:Immunocompetence; D016867:Immunocompromised Host; D008168:Lung / Q000000981:diagnostic imaging; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
Pulmonary; X-ray; computed; cryptococcosis; immunology; infection; tomography