Pulmonary blastomycosis: radiologic manifestations.

Area of Science:

• Pulmonology
• Infectious Diseases
• Radiology

Background:

• Blastomycosis is an airborne fungal infection endemic to the central US.
• Pulmonary involvement is the primary entry point, with diverse clinical presentations.
• Radiographic findings in blastomycosis have been variably described.

Purpose of the Study:

• To analyze the radiographic patterns of pulmonary blastomycosis.
• To determine the association between radiographic patterns and disease stage or symptomatology.

Main Methods:

• Retrospective review of 27 patient cases with confirmed blastomycosis.
• Analysis of chest radiographic findings, categorizing them into four patterns: air-space disease, nodular masses, interstitial disease, and cavitation.

Main Results:

• Four distinct radiographic patterns were identified: air-space disease, nodular masses, interstitial disease, and cavitation.
• Air-space disease was the most common pattern in chronic blastomycosis with non-pulmonary involvement.
• No correlation was found between radiographic pattern and disease distribution, symptoms, or clinical stage.
• The study did not support previous associations of lower lobe disease with early stages and upper lobe disease with chronic/disseminated forms.

Conclusions:

• Pulmonary blastomycosis exhibits diverse radiographic presentations.
• Radiographic patterns alone are insufficient to determine disease chronicity or stage.
• Accurate diagnosis relies on understanding the full spectrum of imaging findings and clinical presentations.