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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 20, Issue 4, Pages 112-116
http://dx.doi.org/10.1155/2009/763018
Original Article

Computed Tomographic Scan Evaluation of Pulmonary Blastomycosis

Suzanne Ronald,1 Jacek Strzelczyk,2 Sean Moore,3 Elly Trepman,4,5 Mary Cheang,6 Bill Limerick,7 Lyle Wiebe,7 Pete Sarsfield,7 Kerry MacDonald,8 Michael Meyers,2 and John M Embil4,9

1School of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
2Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
3Department of Emergency Medicine, Lake of the Woods District Hospital, Kenora, Ontario, Canada
4Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
5Department of Orthopaedic Surgery, Grand Itasca Clinic & Hospital, Grand Rapids, Minnesota, USA
6Department of Community Health Sciences, Statistical Consulting Unit, University of Manitoba, Winnipeg, Manitoba, Canada
7Northwestern Health Unit, Canada
8Department of Pathology, Lake of the Woods District Hospital, Kenora, Ontario, Canada
9Section of Infectious Diseases, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

Copyright © 2009 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: Blastomycosis is an uncommon granulomatous pulmonary and extrapulmonary infectious disease caused by the thermally dimorphic fungus Blastomyces dermatitidis. Diagnosis may be delayed or difficult because of varied presentation. The characteristics of blastomycosis on computed tomographic (CT) scan of the chest are not well characterized.

METHODS: The images from 34 chest CT scans from patients with confirmed pulmonary blastomycosis were retrospectively reviewed.

RESULTS: The most common CT findings were air bronchograms in 22 patients (65%), consolidation in 21 patients (62%), nodules (smaller than 3 cm) in 21 patients (62%) and lymph node enlargement (mediastinal and hilar nodes combined) in 12 patients (35%). Only four patients (12%) had a miliary pattern.

CONCLUSIONS: A specific abnormality characteristic of pulmonary blastomycosis was not identified on CT scanning. The diagnosis can only be made in the context of a high index of clinical suspicion with histological or culture confirmation.