Fig. 4.13 CXR of infectious granulomatous disease

Infectious Granulomatous Disease

Infectious granulomatous diseases are frequently identified as nodules (or mass) on a CXR. This can happen with the following diseases.

•Tuberculosis

•Atypical mycobacterial diseases – especially Mycobacterium Avium-Intracellular (MAI)

•Fungal diseases

–Coccidioidomycosis

–Blastomycosis (North American and South American)

–Cryptococcosis

–Sporotrichosis

•Bacterial diseases, nocardiosis and/or actinomycosis

Case 4.4

The following case (Figs. 4.13 – 4.15) presents a 28-year-old female who had a CXR to monitor a preexisting lesion, though she was asymptomatic at the time of the CXR. She lived in central California.

Fig. 4.14 Lateral CXR of infectious granulomatous disease

Findings: Opacity with central lucency in Left Upper Lobe posteriorly. Pattern: Mass, cavitary.

Differential Diagnosis

Since cavitary, consider the CAVITARY mnemonic differential. Wegener’s granulomatosis can appear just like this.

The standard mass differential:

•Malignancy

•Granulomatous

•Inflammation

•Benign neoplasm

•Congenital

Diagnosis: Coccidiomycosis.

In this case, history helped narrow the diagnosis further, as the patient grew up in the San Joaquin River valley: Coccidiomycosis is also known as San Joaquin Valley Fever.

Signs: Fever, cervical adenopathy, skin lesions, pleural effusion, friction rub, pulmonary rales.