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Pulmonary Cryptococcosis in Immunocompetent Patients: CT Findings in 12 Patients

Danial L. Fox1 and Nestor L. Müller1,2

1 Department of Radiology, Vancouver General Hospital, 899 W 12th Ave., Vancouver, BC V5Z 1M9, Canada.
2 Department of Radiology, The University of British Columbia, 3350-950 W 10th Ave., Vancouver, BC V5Z 4E3, Canada.



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  		Fig. 1A —57-year-old man with pulmonary cryptococcosis. CT image obtained with 1-mm collimation shows spiculated nodule (arrow) in right lower lobe is abutting major fissure.

 


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  		Fig. 1B —57-year-old man with pulmonary cryptococcosis. CT image obtained with 1-mm collimation at same level as A 6 weeks after treatment with fluconazole shows spiculated nodule (arrow) is reduced in size. Diagnosis was confirmed on surgical wedge resection of 17-mm spiculated nodule in anterobasal segment of right lower lobe. Subtyping confirmed var gattii.

 


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  		Fig. 2A —32-year-man with pulmonary cryptococcosis. CT image obtained with 1.25-mm collimation shows two smoothly marginated nodules (arrows) in left upper lobe.

 


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  		Fig. 2B —32-year-man with pulmonary cryptococcosis. CT image at more caudal level than A shows 8-mm thin-walled cavity (arrow) in right lower lobe. Diagnosis was confirmed on bronchoalveolar lavage and sputum culture. Subtyping confirmed var neoformans.

 


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  		Fig. 3 —30-year-old man with pulmonary cryptococcosis. CT image obtained with 5-mm collimation shows multiple predominantly ill-defined nodules in periphery of both lower lobes. Also noted are areas of ground-glass opacification. Diagnosis was confirmed on bronchoalveolar lavage. Subtyping confirmed var neoformans.

 


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  		Fig. 4 —36-year-old man with pulmonary cryptococcosis. CT image obtained with 7-mm collimation shows dense consolidation in right upper lobe with area of cavitation (arrow). Diagnosis was confirmed on bronchoalveolar lavage. No subtyping of organism was performed.

 


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  		Fig. 5A —59-year-old man with pulmonary cryptococcosis. CT image obtained with 7.5-mm collimation shows two peripheral lower lobe pulmonary nodules (arrows).

 


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  		Fig. 5B —59-year-old man with pulmonary cryptococcosis. CT image obtained at more caudal level than A shows right lower lobe nodule (straight arrow) with adjacent enlarged paraesophageal lymph node (curved arrow).

 


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  		Fig. 5C —59-year-old man with pulmonary cryptococcosis. CT image obtained 11 months after A and B shows left lower lobe nodule (arrow) is reduced in size.

 


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  		Fig. 5D —59-year-old man with pulmonary cryptococcosis. CT image obtained 11 months after A and B shows paraesophageal lymph node (arrow) is reduced in size. No subtyping of organism was performed.

 

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