63 Pulmonary Blastomycosis

Clinical Presentation

39-year-old man with cough, fever, chills, and skin lesions

Radiologic Findings

PA chest radiograph (Fig. 63.1A) demonstrates a large mass-like consolidation in the right perihilar region affecting the right upper and lower lobes. Coned-down contrast-enhanced chest CT (lung window) (Figs. 63.1B, 63.1C) demonstrates a mass-like consolidation in the right lower lobe with central air bronchograms (Fig. 63.1B) and multifocal pulmonary nodules in the right lower and middle lobes (Fig. 63.1C). Note trace bilateral pleural effusions.

Diagnosis

Blastomycosis

Fig. 63.1

Differential Diagnosis

• Primary Lung Cancer

• Lung Abscess

• Round Pneumonia

Discussion

Background

North American blastomycosis is a fungal infection endemic to the Mississippi and Ohio River valleys, the midwestern United States, the Canadian provinces near the Great Lakes, and the Saint Lawrence River valley, as well as other regions of the Americas, Europe, and Asia. The fungus grows in nitrogen-rich soil in wooded areas near streams, rivers, and lakes.

Etiology

Blastomycosis is caused by Blastomyces dermatitidis, a fungus acquired by inhalation of infected soil. Many outbreaks occur near recreational water.