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Fungal Infection Mimicking Pulmonary Malignancy: Clinical and Radiological Characteristics

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Abstract

Objective

The purpose of this study was to evaluate the clinical and radiological features of patients with fungal infection mimicking thoracic malignancy and to establish a diagnostic approach for both clinicians and radiologists to avoid misdiagnosis.

Methods

In this retrospective study, we reviewed clinical and computed tomography (CT) findings from 27 patients who presented with suspicion of thoracic malignancy who were ultimately diagnosed with fungal disease.

Results

Patients’ median age was 55.7 (range 31–78) years. The most common clinical findings were cough (48.1 %), expectoration (33.3 %), chest pain (25.9 %), weakness (25.9 %), weight loss (18.5 %), and hemoptysis, dyspnea, and fever (7.4 % each). The median lesion size was 35.5 (range 10–85) mm. CT findings included a solid nodule (51.9 %), solid mass (37 %), or both (11.1 %). Nodule and mass margins were lobulated in 9 (33.3 %) patients, ill-defined in 5 (18.5 %), spiculated in 4 (14.8 %), and smooth in 4 (14.8 %) patients. Additional findings included consolidation in 4 (14.8 %) patients, cavitation in 3 (11.1 %), pleural effusion in 2 (7.4 %), and lymphadenopathy in 11 (40.7 %) patients. In all patients, specific diagnoses were made and confirmed by histopathology; final diagnoses were histoplasmosis (25.9 %), coccidiomycosis (22.2 %), cryptococcosis (22.2 %), aspergillosis (14.8 %), North American blastomycosis (7.4 %), mucormycosis (3.75 %), and paracoccidioidomycosis (3.75 %).

Conclusions

Fungal infection can present with clinical and radiological features that are indistinguishable from thoracic malignancy, such as lung nodules or masses. Because the management and outcomes of fungal infection and malignancy are entirely distinct, the establishment of a specific diagnosis is critical to provide appropriate therapy.

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Acknowledgments

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Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Imaging, AC Camargo Cancer Center, Rua Paulo Orozimbo, 726, Aclimação, São Paulo, SP, 01535-001, Brazil

    Marcos Duarte Guimarães & Almir Galvão Vieira Bitencourt

  2. Department of Radiology, Universidade Federal do Rio de Janeiro, Rua Thomaz Cameron, 438, Valparaiso, Petrópolis, RJ, 25685-120, Brazil

    Edson Marchiori

  3. Department of Radiology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil

    Gustavo de Souza Portes Meirelles

  4. Department of Radiology, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Prof. Annes Dias, 295, Centro, Porto Alegre, RS, 90020-090, Brazil

    Bruno Hochhegger

  5. Department of Radiology, Beneficiência Portuguesa de São Paulo, Rua Maestro Cardim, 769, Bela Vista, São Paulo, SP, 01323-900, Brazil

    Pablo Rydz Pinheiro Santana

  6. Department of Thoracic Surgery, AC Camargo Cancer Center, Rua Paulo Orozimbo, 726, Aclimação, São Paulo, SP, 01535-001, Brazil

    Jefferson Luiz Gross

  7. Department of Diagnostic Radiology, MD Anderson Cancer Center, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Piyaporn Boonsirikamchai & Myrna Corbos Barco Godoy

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  1. Marcos Duarte Guimarães
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  2. Edson Marchiori
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  8. Piyaporn Boonsirikamchai
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  9. Myrna Corbos Barco Godoy
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Correspondence to Marcos Duarte Guimarães.

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Guimarães, M.D., Marchiori, E., de Souza Portes Meirelles, G. et al. Fungal Infection Mimicking Pulmonary Malignancy: Clinical and Radiological Characteristics. Lung 191, 655–662 (2013). https://doi.org/10.1007/s00408-013-9506-0

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  • DOI: https://doi.org/10.1007/s00408-013-9506-0

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