Pulmonary blastomycosis: findings on chest radiographs in 63 patients

Posteroanterior and lateral chest radiographs of 63 patients with proved pulmonary blastomycosis were evaluated to determine the most common findings. Included in the analysis were the location of the pulmonary infiltrates, the distribution and parenchymal patterns of disease, and the prevalence of adenopathy, pleural effusions, and/or cavity formation. Blastomycosis pneumonitis involved more than one pulmonary lobe in 21 patients and a single upper lobe in 27 of 63 patients. Forty-eight of the 63 patients had air-space consolidation. In nine of the 63 patients, a pulmonary mass was the major abnormality seen on radiographs. Approximately one fifth of the patients had associated pleural effusions and/or mediastinal or hilar adenopathy. Twenty-three patients (37%) had cavitation within the area of pulmonary consolidation. These findings suggest that blastomycosis should be considered when chest radiographs show air-space infiltrate in the upper lobes or in more than one lobe of the lung, especially when the infiltrate is associated with pleural effusions, cavitation, lymphadenopathy, and/or a paramediastinal mass.