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THE VARIED ROENTGEN MANIFESTATIONS OF PRIMARY COCCIDIOIDOMYCOSIS

WILLIAM H. GREENDYKE COLONEL, USAF, MC1, DONALD L. RESNICK CAPTAIN, USAF, MC2, and WILLIAM C. HARVEY MAJOR, USAF, MC3

1 Chairman, Department of Radiology, Wilford Hall USAF Medical Center, Lackland Air Force Base, Texas.
2 Chief of Radiology, 4510 USAF Hospital, Luke Air Force Base, Arizona.
3 Chief of Department of Internal Medicine, 4510 USAF Hospital, Luke Air Force Base, Arizona.

A study of 59 cases of acute coccidioidomycosis admitted to the 4510 USAF Hospital, Luke AFB, Arizona, between January 1, 1967 and December 31, 1968 was conducted to define the roentgen manifestations of acute coccidioidomycosis. A wide spectrum of roentgen abnormalities was experienced. The most common manifestation was found to be pneumonitis. Pleural effusion and hilar and mediastinal enlargement were the next most frequent modes of presentation. Combinations of roentgen abnormalities such as infiltrate and lymphadenopathy or infiltrate and effusion were common. A high incidence of skin lesions, comprised of toxic erythema, erythema nodosum, and erythema multiforme, were found in patients with acute disease.

Recognizing the large transient military population and annual tourist exposure in the endemic southwestern United States, awareness of the varied forms of presentation of coccidioidomycosis seems increasingly appropriate for radiologists in non-endemic areas.

Although the roentgen findings of this disease are nonspecific, the radiologist can demonstrate a high degree of accuracy in diagnosis of coccidioidomycosis if he is aware of its wide spectrum of roentgen manifestations and requests information regarding patient exposure to the endemic region. The validity of the diagnosis can be further enhanced by a knowledge of the patient’s clinical picture, particularly the presence of skin lesions. Realization of the temporal limitations of the coccidioidin skin test in acute disease should defer diagnostic thoracotomy when environmental history and roentgenographic evidence favors coccidioidomycosis.


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