Korean J Radiol.  2013 Jun;14(3):540-543. 10.3348/kjr.2013.14.3.540.

Case of Pulmonary Cryptococcosis Mimicking Hematogeneous Metastases in an Immuocompetent Patient: Value of Absent 18F-Fluorodeoxylucose Uptake on Positron Emission Tomography/CT Scan

Affiliations
  • 1Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan, Republic of China. hsianhe@yahoo.com.tw
  • 2Department of Thoracic Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan, Republic of China.
  • 3Department of Pathology, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan, Republic of China.

Abstract

The radiologic appearance of multiple discrete pulmonary nodules in immunocompetent patients, with cryptococcal infection, has been rarely described. We describe a case of pulmonary cryptococcosis, presenting with bilaterally and randomly distributed nodules on a computed tomography, mimicking hematogeneous metastases. Positron emission tomography does not demonstrate 18F-fluorodeoxyglucose (FDG) uptake, suggesting a low probability for malignancy, which is a crucial piece of information for clinicians when making a management decision. We find the absence of FDG uptake correlates with the pathologic finding of an infectious nodule, composed of fibrosis and necrosis.

Keyword

Cryptococcosis; Positron emission tomography; Neoplasm metastasis; Multiple pulmonary nodules

MeSH Terms

Cryptococcosis/metabolism/*radionuclide imaging
Fluorodeoxyglucose F18/*diagnostic use/pharmacokinetics
Humans
Immunocompetence
Lung Diseases, Fungal/metabolism/*radionuclide imaging
Lung Neoplasms/radionuclide imaging
Male
Middle Aged
Multimodal Imaging/*methods
Multiple Pulmonary Nodules/radionuclide imaging
Positron-Emission Tomography/*methods
Radiopharmaceuticals/*diagnostic use/pharmacokinetics
Tomography, X-Ray Computed/*methods
Fluorodeoxyglucose F18
Radiopharmaceuticals

Figure

  • Fig. 1 Multiple nodular pattern of cryptococcal infection in 49-year-old man. A. Accidental findings of multiple pulmonary nodules (arrowheads) in bilateral lung fields in chest radiography. B. High resolution CT shows four pulmonary nodules (arrows) with well-defined margin without associated lung infiltration in axial plane. Maximal size of few nodules is larger than 1 cm and they show obvious soft tissue contains in mediastinal window. C. Fluorodeoxyglucose (FDG) positron emission tomography scan shows totally absent FDG uptake in lung fields. D. Numerous cryptococcal spores are stained in surgical specimen in Grocott's methenamine silver stain smear (400 ×) and prove diagnosis of pulmonary cryptococcosis. E. Hematoxylin and eosin stain smear (100 ×) demonstrates central necrotic tissue with only mild inflammatory cells infiltration, which is compatible with positron emission tomography results.


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