Acute pulmonary coccidioidomycosis: CT findings from 15 patients

The aim of this study was to describe the CT scan abnormalities in 15 patients with acute pulmonary coccidioidomycosis. Retrospective analysis of chest CT scans from 15 patients with acute pulmonary coccidioidomycosis was performed. The final diagnosis included the finding of Coccidioides immitis in mycology and/or histopathology, complemented by serology. Two radiologists evaluated the CT scans to study the type, size, profusion and localization of the findings. The final decisions were defined by consensus. CT scans showed multiple bilateral nodules in 13 patients and solitary nodules associated with consolidation in 2 cases. The nodules had ill-defined contours, ranging from 0.5 cm to 3.0 cm in diameter, which were predominant in the lower lobes in 11 cases. Cavitation of nodules was observed in 13 cases and coalescence in 7. Nodule-associated abnormalities were found in 13 cases, comprising interlobular septal thickening (n=7) and consolidations (n=6). Other abnormalities included lymph node enlargement (n=6) and small pleural effusion (n=2). In conclusion, the main CT finding in patients with acute coccidioidomycosis was that of multiple nodules (0.5-3.0 cm) at the lungs bases; a significant proportion of the remaining cases also showed other abnormalities. A diagnosis of coccidioidomycosis must be considered in patients with multiple lung nodules that are either in, or have recently been transported to, areas of endemic mycosis. (c) The British Institute of Radiology.