Pulmonary coccidiodomycosis

Case contributed by Dr Jayanth Keshavamurthy

Presentation

40 year old from Arizona.

Patient Data

Age: 40
Gender: Female

Can you spot the abnormality

Modality: X-ray

Dual energy radiography, how useful the bone subtracted image helps in identifying the abnormality.

Magnifed and focussed image

Modality: Annotated image

This is a zoomed image of right apex in dual energy subtracted view.

8 years later

Modality: X-ray

Dual energy radiograph, how useful the bone subtracted image helps in identifying the abnormality in the prior study. The nodule is stable 8 years later.

Case Discussion

She has a complicated medical history that began in late 2004 or early 2005 when she lived out in Arizona, and was heralded with a cough, fever, and sweats.  

CT scan at that time showed some nodular infiltrates and she underwent bronchoscopy for suspected coccidioidomycosis.  Bronchoscopy was reported to be negative at that time as were her cocci titers from blood.  

She was still felt to have cocci and was treated with Diflucan for 10 to 12 months, and during that time, felt much better, although not completely normal.  

She got worse again sometime in 2007 and once again had a repeat bronchoscopy this time found that again the bronchoscopy and cocci titers were negative.  

She was treated again with Diflucan for about 10 months and felt better.  

In the interim, she has had frequent CT scans to follow some residual cavities and nodules and these have been relatively stable until June of 2009 when one of the previous cavities filled in and became completely solid.   

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Case Information

rID: 38721
Case created: 30th Jul 2015
Last edited: 2nd Apr 2016
System: Chest
Inclusion in quiz mode: Included

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