eMedicine Specialties > Radiology > Chest

Blastomycosis, Thoracic: Multimedia

Author: Fahad M Alhameed, MD, AmBIM, FCCP, FRCPC, Deputy Chairman of Intensive Care Department, Consultant Critical Care and Pulmonary Medicine, Department of Intensive Care and Pulmonary Medicine, King Khalid National Guard Hospital, Jeddah, Saudi Arabia
Coauthor(s): Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St. Boniface General Hospital; Bruce Maycher, MD, Director of Pulmonary Radiology, St Boniface General Hospital; Associate Professor, Department of Radiology, University of Manitoba
Contributor Information and Disclosures

Updated: Oct 17, 2008

Multimedia

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Media file 1: A patient visited central Canada several months ago. He developed cough, fever, and dyspnea. Chest radiograph demonstrates focal patchy opacity in the lingula. Blastomyces dermatitidis was identified on bronchoscopy.

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A patient visited central Canada several months ago. He developed cough, fever, and dyspnea. Chest radiograph demonstrates focal patchy opacity in the lingula. Blastomyces dermatitidis was identified on bronchoscopy.

(Enlarge Image)

Media file 2: Lateral chest radiograph (same patient as in Image 1) reveals the ill-defined lingular opacity and an absence of pleural effusions.

[ CLOSE WINDOW ]

Lateral chest radiograph (same patient as in Image 1) reveals the ill-defined lingular opacity and an absence of pleural effusions.

(Enlarge Image)

Media file 3: A patient on mechanical ventilation because of acute respiratory distress secondary to diffuse blastomycosis. Bilateral pneumothoraces are the result of barotrauma. Right chest wall subcutaneous emphysema resulted from chest tube placement.

[ CLOSE WINDOW ]

A patient on mechanical ventilation because of acute respiratory distress secondary to diffuse blastomycosis. Bilateral pneumothoraces are the result of barotrauma. Right chest wall subcutaneous emphysema resulted from chest tube placement.

(Enlarge Image)

Media file 4: Chest CT image reveals patchy, dense lung opacification in the right middle and lower lobes. This is the most common presentation of blastomycosis. Lung opacities may be patchy or confluent and subsegmental or nonsegmental.

[ CLOSE WINDOW ]

Chest CT image reveals patchy, dense lung opacification in the right middle and lower lobes. This is the most common presentation of blastomycosis. Lung opacities may be patchy or confluent and subsegmental or nonsegmental.

(Enlarge Image)

Media file 5: Chest radiograph demonstrates a spiculated mass overlying the left hilum. This radiographic finding mimics that of bronchogenic carcinoma; thus, a biopsy is needed for tissue diagnosis.

[ CLOSE WINDOW ]

Chest radiograph demonstrates a spiculated mass overlying the left hilum. This radiographic finding mimics that of bronchogenic carcinoma; thus, a biopsy is needed for tissue diagnosis.

(Enlarge Image)

Media file 6: Lateral chest radiograph (same patient as in Image 5) reveals the central mass overlying the left hilum.

[ CLOSE WINDOW ]

Lateral chest radiograph (same patient as in Image 5) reveals the central mass overlying the left hilum.

(Enlarge Image)

Media file 7: Chest radiograph from a patient with pulmonary blastomycosis demonstrates multiple nodular lesions, some of which are cavitating, in the left lower lobe. Cavitation occurs in 15-20% of patients with blastomycosis.

[ CLOSE WINDOW ]

Chest radiograph from a patient with pulmonary blastomycosis demonstrates multiple nodular lesions, some of which are cavitating, in the left lower lobe. Cavitation occurs in 15-20% of patients with blastomycosis.

(Enlarge Image)

Media file 8: Chest CT (same patient as in Image 7) reveals a thick wall cavity in the left lower lobe with surrounding focal parenchymal disease; needle biopsy of this lesion confirmed blastomycosis. Cavitation occurs in 15-20% of patients with blastomycosis.

[ CLOSE WINDOW ]

Chest CT (same patient as in Image 7) reveals a thick wall cavity in the left lower lobe with surrounding focal parenchymal disease; needle biopsy of this lesion confirmed blastomycosis. Cavitation occurs in 15-20% of patients with blastomycosis.

(Enlarge Image)

Media file 9: Chest radiograph from a patient with disseminated blastomycosis demonstrates diffuse miliary infiltrates associated with respiratory failure that required mechanical ventilation. In this patient, dense opacification with cavitation is seen in the right upper lobe. In a minority of patients, a diffuse micronodular pattern is seen; such a pattern results from hematogenous spread of the disease.

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Chest radiograph from a patient with disseminated blastomycosis demonstrates diffuse miliary infiltrates associated with respiratory failure that required mechanical ventilation. In this patient, dense opacification with cavitation is seen in the right upper lobe. In a minority of patients, a diffuse micronodular pattern is seen; such a pattern results from hematogenous spread of the disease.

(Enlarge Image)

Media file 10: Chest radiograph from a patient with blastomycosis reveals left hilar lymphadenopathy, an uncommon finding in patients with blastomycosis.

[ CLOSE WINDOW ]

Chest radiograph from a patient with blastomycosis reveals left hilar lymphadenopathy, an uncommon finding in patients with blastomycosis.

More on Blastomycosis, Thoracic

Overview: Blastomycosis, Thoracic

Imaging: Blastomycosis, Thoracic

Follow-up: Blastomycosis, Thoracic

Multimedia: Blastomycosis, Thoracic

References

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Wisconsin Department of Health Services. RARE FUNGAL INFECTION CAN GO UNDIAGNOSED. Last revised Sept. 12, 2008. Wisconsin Department of Health Services. Available at http://dhs.wisconsin.gov/News/PressReleases/2008/091208Blasto.htm. Accessed October 17, 2008.
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Brown LR, Swensen SJ, Van Scoy RE, et al. Roentgenologic features of pulmonary blastomycosis. Mayo Clin Proc. Jan 1991;66(1):29-38. [Medline].
Fang W, Washington L, Kumar N. Imaging manifestations of blastomycosis: a pulmonary infection with potential dissemination. Radiographics. May-Jun 2007;27(3):641-55. [Medline].
Sheflin JR, Campbell JA, Thompson GP. Pulmonary blastomycosis: findings on chest radiographs in 63 patients. AJR Am J Roentgenol. Jun 1990;154(6):1177-80. [Medline].
Washington L, Palacio D. Imaging of bacterial pulmonary infection in the immunocompetent patient. Semin Roentgenol. Apr 2007;42(2):122-45. [Medline].
Winer-Muram HT, Beals DH, Cole FH Jr. Blastomycosis of the lung: CT features. Radiology. Mar 1992;182(3):829-32. [Medline].
Day TA, Stucker FJ. Blastomycosis of the paranasal sinuses. Otolaryngol Head Neck Surg. Apr 1994;110(4):437-40. [Medline].
Lagerstrom CF, Mitchell HG, Graham BS, Hammon JW Jr. Chronic fibrosing mediastinitis and superior vena caval obstruction from blastomycosis. Ann Thorac Surg. Oct 1992;54(4):764-5. [Medline].
Lagging LM, Breland CM, Kennedy DJ, et al. Delayed treatment of pulmonary blastomycosis causing vertebral osteomyelitis, paraspinal abscess, and spinal cord compression. Scand J Infect Dis. 1994;26(1):111-5. [Medline].
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Keywords

blastomycosis, thoracic blastomycosis, Blastomyces dermatitidis, pulmonary blastomycosis, disseminated blastomycosis, blastomycetoma, blastocytoma, Gilchrist disease, mycosis, mycoses

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Contributor Information and Disclosures

Author

Fahad M Alhameed, MD, AmBIM, FCCP, FRCPC, Deputy Chairman of Intensive Care Department, Consultant Critical Care and Pulmonary Medicine, Department of Intensive Care and Pulmonary Medicine, King Khalid National Guard Hospital, Jeddah, Saudi Arabia
Fahad M Alhameed, MD, AmBIM, FCCP, FRCPC is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, Canadian Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St. Boniface General Hospital
Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association
Disclosure: Nothing to disclose.

Bruce Maycher, MD, Director of Pulmonary Radiology, St Boniface General Hospital; Associate Professor, Department of Radiology, University of Manitoba
Bruce Maycher, MD is a member of the following medical societies: American Roentgen Ray Society, Canadian Medical Association, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

Medical Editor

Satinder P Singh, MD, Associate Professor of Radiology, Chief of Cardiopulmonary Radiology, Director of Cardiac CT, Director of Combined Cardiopulmonary and Abdominal Radiology, Department of Radiology, University of Alabama at Birmingham
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Eric J Stern, MD, Professor of Radiology, Adjunct Professor of Medicine, Adjunct Professor of Medical Education and Biomedical Informatics, University of Washington School of Medicine; Director of Thoracic Imaging, Harborview Medical Center; Associate Medical Staff, Seattle Cancer Care Alliance
Eric J Stern, MD is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, European Society of Radiology, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Clinical Assistant Professor of Radiology, University of Washington Medical School
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

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eMedicine Specialties > Radiology > Chest

Blastomycosis, Thoracic: Multimedia

Multimedia

A patient visited central Canada several months ago. He developed cough, fever, and dyspnea. Chest radiograph demonstrates focal patchy opacity in the lingula. Blastomyces dermatitidis was identified on bronchoscopy.

Lateral chest radiograph (same patient as in Image 1) reveals the ill-defined lingular opacity and an absence of pleural effusions.

A patient on mechanical ventilation because of acute respiratory distress secondary to diffuse blastomycosis. Bilateral pneumothoraces are the result of barotrauma. Right chest wall subcutaneous emphysema resulted from chest tube placement.

Chest CT image reveals patchy, dense lung opacification in the right middle and lower lobes. This is the most common presentation of blastomycosis. Lung opacities may be patchy or confluent and subsegmental or nonsegmental.

Chest radiograph demonstrates a spiculated mass overlying the left hilum. This radiographic finding mimics that of bronchogenic carcinoma; thus, a biopsy is needed for tissue diagnosis.

Lateral chest radiograph (same patient as in Image 5) reveals the central mass overlying the left hilum.

Chest radiograph from a patient with pulmonary blastomycosis demonstrates multiple nodular lesions, some of which are cavitating, in the left lower lobe. Cavitation occurs in 15-20% of patients with blastomycosis.

Chest CT (same patient as in Image 7) reveals a thick wall cavity in the left lower lobe with surrounding focal parenchymal disease; needle biopsy of this lesion confirmed blastomycosis. Cavitation occurs in 15-20% of patients with blastomycosis.

Chest radiograph from a patient with blastomycosis reveals left hilar lymphadenopathy, an uncommon finding in patients with blastomycosis.

More on Blastomycosis, Thoracic

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor