The radiological manifestation of the deep mycoses

Lee, Y H; Choi, B S

Abstract

Total 23 cases of deep mycoses were reviewed on the clinical and radiographic findings, which were confirmedpathologically at Yonsei Univ. College of Medicine, Severence Hospital until 1976. Summary of these was asfollows; 1) Aspergillosis; 11 cases. 1. Although one case among them was systemic aspergillosis, all 11 cases hadpulmonary aspergillsis. 2. They occured most commonly in 3rd or 4th decase and its main complaints wereintermittent hemoptysis for a long time or occasionally massive one for a few days. All cases were treated aspulmonary tuberculosis but the lesions showed poor response to anti-tuberculous medication. 3. Their chest X-rayilms revealed irregular mottled infiltrate (6 cases) or collapse and massive, dense consolidation (2 cases). Amongthem, 7 cases showed various form of "air meniscus sign" suggesting fungus ball, which was able to be detectableon tomography. Another finding was diffuse pneumonic pattern in 2 cases, which was not able to be differenciatedfrom other pathologic origin pneumonia. 4. Nine cases were belonged to mycetoma form, 2 cases were primaryaspergillosis and there is no hypersenitivity aspergillosis in these cases, if these cases were classified. 2)Cryptococcosis : 8 cases. 1. Among 8 cases, 5 cases were crytococcal meningitis, 5 cases of them were thought tobe pulmonary crytococcosis, liver biopsy was positive in 4 cases and lymph node biopsy in 4 cases, including 2cases of systemic cryptococcosis. 2. It occured commonly at the 1st decade and their clinical findings weremultiple lymphadenopathy, uncontrolled fever, meningeal irritation symptoms such as severe headache, vomiting ordrowsy or coase interstitial nodules were scattered in entire lung with lymphadenopathy in 3 cases, which shouldbe differenciated from miliary tuberculosis, sarcoidosis and lymphangitic pulmonary metastasis. 3) Actinomycosis :2 cases. 1. Both of two cases with subcutaneous abscess were diagnosed as the actinomycotic infection. 2. In one,neighbouring rib showed localized sclerosis and minimal bony rarefaction suggesting chronic osteomyelitis. Thisradiologic or clinical manifestation of actinomycosis is somewhat different form the literatures. 4) Mucomycosis :1 case 1. A 34 years old, in diabetic coma, was diagnosed as the pulmonary mucormycosis. 2. Pulmonary lesionshowed segmental, dense pneumonic consolidation with abscess formation in lt. lower lung, which was commonfeatures of pulmonary mucormycosis. 5) Candidiasis : 1 case 1. A 19 years old patient was diagnosed as diffuseinvolvement of Candida infection, with pathologic lesions of lung and entire gastrointestinal tract. 2. The lumenof distal esophagus was narrowed with irregular coarse mucosa with fine, multiple ulceration and minimal mucosalthickening of duodenal bulb and ileocecal area was also evident.