Plain and contrast-enhanced chest computed tomography scan findings of pulmonary cryptococcosis in immunocompetent patients

Pulmonary cryptococcosis is most commonly reported in immunocompromised patients, whereas immunocompetent hosts are rarely affected and may be asymptomatic, resulting in reduced diagnostic performance of computed tomography (CT) imaging. Thus, the aim of the present study was to review the plain and contrast-enhanced chest CT scan findings of primary pulmonary cryptococcosis in immunocompetent patients, with the aim of improving the diagnosis of this type of pulmonary disease. In the present study, a total of 27 immunocompetent patients of clinically confirmed pulmonary cryptococcosis were analyzed retrospectively. Of the 27 patients, 14 patients underwent plain and contrast-enhanced chest CT scans, while 13 patients only underwent plain chest CT scanning. The clinical and imaging characteristics, including the location, shape, size, number, edge and attenuation or intensity of each lesion, in unenhanced and contrast-enhanced CT scans were reviewed. The results indicated that the most common CT finding was pulmonary nodules (40.74%), with multiple nodules (25.93%) being more common compared with solitary nodules (14.81%). The majority of the nodules were poorly defined and inhomogeneous with observed air-bubble sign. Other findings included consolidation (25.93%), ground-glass opacities (GGO; 22.22%) and a mass (11.11%). The halo, air bronchogram and cavity signs were observed more frequently (22.22, 18.52 and 14.81%, respectively). The pulmonary lesions presented a predominant distribution in the lower lung lobes and peripheral area in 55.55 and 74.07% of the cases, respectively. On the contrast-enhanced CT images, the majority of nodules presented ring enhancement with the mean maximal enhancement value of 20.92 +/- 5.67 Hu, and masses demonstrated inhomogeneous enhancement with a mean maximal enhancement value of 35.61 +/- 8.32 Hu. In conclusion, familiarity with the CT findings and occupational environment exposure history will assist in earlier and easier diagnosis of pulmonary cryptococcosis in immunocompetent patients.