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DOI:10.2214/AJR.07.7013
AJR 2008; 190:S11-S17
© American Roentgen Ray Society

Radiological Reasoning: Miliary Disease, Vertebral Osteomyelitis, and Soft-Tissue Abscesses

Gregory E. Wilde1, Christine Emery1 and James F. Lally1

1 Department of Radiology, Christiana Care Health System, 4755 Ogletown-Stanton Rd., Newark, DE 19718.

Objective

We present a case of disseminated coccidioidomycosis with miliary disease and extrathoracic spread to the breast, the retroperitoneum, the soft tissues of the neck, and multiple vertebrae with spinal cord compression. We discuss the differential diagnosis of the imaging presentation, as well as the specific clinical and imaging features of coccidioidomycosis.

Conclusion

Disseminated coccidioidomycosis in a nonendemic area can be difficult to diagnose, even with an excellent clinical history, as almost every organ system can be involved. Widespread disease can be seen and spinal involvement can easily be mistaken for malignancy, Pott's disease, or other granulomatous disease. Miliary disease with concomitant breast involvement is a rare presentation of disseminated disease. Detection of specific radiographic patterns of involvement and recognition of travel to or from an endemic area can lead to an accurate diagnosis and earlier treatment.

Keywords: CNS • disseminated coccidioidomycosis • Coccidioides immitis • miliary pattern • soft-tissue abscesses • vertebral osteomyelitis


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