Chronic pulmonary coccidioidomycosis: computed tomographic and pathologic findings in 18 patients

To review the computed tomographic (CT) findings in pathologically proven chronic pulmonary coccidioidomycosis.

The study included 19 pulmonary lesions caused by mycologically and pathologically proven chronic coccidioidomycosis in 18 immunocompetent patients (aged 22 to 75 years, mean 57 years) who had a chest CT scan. Thirteen patients were Canadians who had travelled to an endemic area, and 5 were inhabitants of an endemic area in southern California and Arizona. The CT findings were assessed to determine the type, size, margin, internal architecture and location of parenchymal abnormalities.

The CT findings included solitary nodules of 1.0 to 2.0 cm (mean 1.7 cm) in diameter in 17 patients, a focal area of ground-glass attenuation in 1 patient, and focal consolidation in 1 patient. Ten of the nodules had homogeneous attenuation on CT, 2 had central areas of low attenuation, 2 showed cavitation, 2 had foci of calcifications and 1 had bubble lucency. The nodules were located peripherally (in 14 patients) and centrally (in 3 patients). The predominant histologic finding in these nodules was a necrotizing granuloma. Three nodules were surrounded by halos of ground-glass attenuation, which were shown on histologic examination to represent granulomatous inflammation (in 2 cases) and pulmonary hemorrhage due to a pulmonary artery-bronchial fistula (in 1 case). Two nodules had adjacent consolidation, which was due to granulomatous inflammation surrounding a necrotizing granuloma.

Necrotizing granulomas in chronic coccidioidomycosis appear as a well-defined nodule on CT, while granulomatous inflammation may appear as areas of ground-glass attenuation or consolidation.