Abstract
Computerized tomography (CT) plays an important role in the diagnosis of pulmonary nocardiosis (PN), allowing earlier detection and better characterization of the abnormalities than does chest radiography. The aim of the present study was to review reported radiographic clues to the diagnosis of PN at the time of initial presentation. A computerized database search was performed to find all cases of PN, confirmed positive culture, in patients at our institution over the last 11 years. Twenty six patients (n=26) with PN were identified. Patients without CT scan available at initial presentation (n=2) and patients with concurrent diseases involving the lungs and pleura were excluded (n=2). For the remaining 22 patients [median age: 46 years (range, 21 to72 y)], standardized radiographic features were recorded. Some form of immunosuppression was present in 95 % of the cases. Preexisting structural abnormalities of the lung were uncommon (COPD : 2). CT features of PN included one or more nodules/ masses (16 patients, 73%), airspace consolidation / infiltrates (12 patients, 55 %), pleural effusion/ thickening (9 patients, 41%), mediastinal lymphadenopathy (6 patients, 27%), diffuse interstitial pattern (4 patients, 18%), chest wall extension (2 patients, 9%). Cavitary lesions with /without internal low attenuation including nodules, masses, or airspace disease, occurred in 64 % of the patients. CT findings of PN in immunocompromised patients are pleomorphic and not specific. CT findings consist predominantly of nodules/ masses and cavitary lesions without any significant zonal or anatomic distribution. Diffuse interstitial patterns also occur. Pleural effusions are quite common, and lymph nodes may be enlarged.
- © 2012 ERS
