Imaging
Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology.
The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend. Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology. The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend.
Medical Image of the Week: Disseminated Coccidioidomycosis
Figure 1. Thoracic CT with diffuse bilateral ground glass opacities with extensive nodularity. Though present throughout all lobes, it is worse in the upper lobes.
Figure 2. Scattered papular lesions with biopsy positive for coccidioidomycosis spherules.
A 67-year-old African American man with no significant past medical history presented with shortness of breath and flu-like symptoms. On exam, he was noted to be profoundly hypoxemic with imaging showing diffuse thoracic changes (Figure 1) and a diffuse papular rash (Figure 2). Initial workup included coccidioidomycosis serologies which returned positive with a titer of 1:128.
While exposure to coccidioidomycosis is very common in southern Arizona, dissemination is a rare occurrence. The incidence is estimated between 0.2 and 4.7 percent. Patients at highest risk include those that are immunosuppressed or that are of African or Filipino ancestry. Common extra-pulmonary sites include skin or subcutaneous tissue, meninges of brain or spinal cord, and bones. Even rarer sites include the eyes, liver, prostate, mediastinum, and kidneys. Treatment is usually the same as with pulmonary infection which is an azole agent. However, if the patient’s symptoms are severe or if the lesions involve the spine, amphotericin is recommended instead. Steroid use is controversial but may be beneficial in severe cases. Unfortunately, our patient did not respond to the combination of fluconazole plus amphotericin and succumbed to his severe disease.
Tiffany Ynosencio, MD
Division of Pulmonary, Allergy, Critical Care and Sleep
Banner-University Medical Center
Tucson, AZ USA
References
- Crum NF, Lederman ER, Stafford CM, Parrish JS, Wallace MR. Coccidioidomycosis: a descriptive survey of a reemerging disease. Clinical characteristics and current controversies. Medicine (Baltimore). 2004 May;83(3):149-75. [CrossRef] [PubMed]
- Adam RD, Elliott SP, Taljanovic MS. The spectrum and presentation of disseminated coccidioidomycosis. Am J Med. 2009 Aug;122(8):770-7. [CrossRef] [PubMed]
- Galgiani JN. Manifestations and treatment of extrapulmonary coccidioidomycosis. UpToDate Jan 02, 2017. Available at: http://www.uptodate.com/contents/manifestations-and-treatment-of-extrapulmonary-coccidioidomycosis (requires subscription).
Cite as: Ynosencio T. Medical image of the week: disseminated coccidioidomycosis. Southwest J Pulm Crit Care. 2017;14(2):65-6. doi: https://doi.org/10.13175/swjpcc011-17 PDF
November 2015 Imaging Case of the Month
Michael B. Gotway, MD
Department of Radiology
Mayo Clinic Arizona
Scottsdale, AZ
Clinical History: A 48-year-old non-smoking woman with a history of hysterectomy and right oophorectomy, and cholecystectomy, otherwise previously healthy, presented with right-sided chest pain. A frontal chest radiograph (Figure 1) was performed.
Figure 1. Frontal chest radiograph.
Which of the following statements regarding the chest radiograph is most accurate? (Click on the correct answer to proceed to the second of eight panels)
Cite as: Gotway MB. November 2015 imaging case of the month. Southwest J Pulm Crit Care. 2015;11(5):218-25. doi: http://dx.doi.org/10.13175/swjpcc140-15 PDF