Clinical and Computed Tomography (CT) Characteristics of Pulmonary Nodules Caused by Cryptococcal Infection

Figures & data

Table 1 Patients’ Clinical Characteristics

Characteristics	Patients with Solitary Nodules (n = 25)	Patients with Multiple Nodules (n = 22)	P-value
Gender (Male/Female)	15/10	13/9	0.949
Mean age (year)	50.0 ± 12.3	43.6 ± 12.8	0.088
Symptoms (+)	8 (32.0)	13 (59.1)	0.062
Fever	1	4
Cough	7	7
Sputum	4	6
Chest pain	0	1
Hemoptysis	0	1
Concomitant basic diseases	7 (28.0)	9 (40.9)	0.351
HIV infection	2	5
Malignant tumors	3	0
Chronic kidney disease	0	2
Kidney transplant	0	1
Diabetes	2	1

Note: Data are expressed as mean ± SD or n (%).

Abbreviation: HIV, human immunodeficiency virus.

Table 2 CT Characteristics of Solitary and Multiple Nodules

Characteristics	Single Nodular Pattern (n = 25)	Multiple Nodular Pattern (n = 22)	P-value
Size (range) (mm)	10.6 ± 3.5 (5–18)	18.0 ± 6.9 (5–29)	0.000
Lobe location			0.136
Right upper lobe	8 (32.0)	7 (25.9)
Right middle lobe	2 (8.0)	1 (3.7)
Right lower lobe	4 (16.0)	13 (48.2)
Left upper lobe	5 (20.0)	2 (7.4)
Left lower lobe	6 (24.0)	4 (14.8)
CT patterns			0.164
Solid	22 (88.0)	20 (90.9)
pGGN	0 (0.0)	1 (4.6)
mGGN	3 (12.0)	0 (0.0)
Solid + GGN	0 (0.0)	1 (4.6)
Distribution			0.031
Subpleural zone	13 (52.0)	18 (81.8)
Non-subpleural zone	12 (48.0)	4 (18.2)
Boundary			0.358
Well-defined	15 (60.0)	16 (72.7)
Ill-defined	10 (40.0)	6 (27.3)
Cavity and vacuole	3 (12.0)	8 (36.4)	0.049
Cavity	1 (33.3)	7 (87.5)
Vacuole	2 (66.7)	1 (12.5)
Air bronchogram	9 (36.0)	6 (27.3)	0.522
Halo sign	7 (28.0)	10 (45.5)	0.214
Enhancement			0.080
No significant enhancement (< 20 HU)	2 (22.2)	0
Slight enhancement (20–40HU)	3 (33.3)	9 (75.0)
Significant enhancement (> 40HU)	4 (44.4)	3 (25.0)
Hilar or mediastinal lymphadenectasis	0	4 (18.2)	-
Pleural effusion	0	2 (9.1)	-
Pericardial effusion	0	1 (4.6)	-

Note: Data are expressed as mean ± SD or n (%).

Abbreviations: GGN, ground glass nodule; pGGN, pure GGN; mGGN, mixed GGN.

Figure 1 A 24-year-old woman with HIV infection and pulmonary cryptococcosis. She has headache and fever for ten days, and cryptococcal meningitis is confirmed. (A and B) Axial CT images show multiple clustered nodules with different sizes located in the subpleural zone of right lower lobe. (B) Cavities are detected in the bigger nodules.

Figure 2 A 24-year-old man with HIV infection and pulmonary cryptococcosis. He has headache and fever for a week, and cryptococcal meningitis is confirmed. (A and B) Axial CT images show multiple scattered nodules with different sizes in the right lower lobe, and cavities are detected in the bigger nodules.

Figure 3 Patients with pulmonary cryptococcosis presented as solitary solid nodules. (A) Axial CT image in a 48-year-old asymptomatic man shows a round and well-defined nodule with small bronchi located in the right upper lobe. (B) Coronal CT image in a 54-year-old asymptomatic man shows a round and well-defined nodule with vacuole located in the left upper lobe. (C) Coronal CT image in a 50-year-old asymptomatic man shows an ill-defined nodule with a satellite lesion (red arrow) located in the right upper lobe. (D) Axial CT image in a 49-year-old asymptomatic woman shows an oval nodule with halo sign located in the left upper lobe.

Figure 4 Patients with pulmonary cryptococcosis presented as solitary subsolid nodules. (A and B) Axial and sagittal CT images in a 60-year-old asymptomatic woman show an oval and ill-defined mixed GGN with strip shaped solid component located in the left upper lobe. (C and D) Axial CT images in a 50-year-old asymptomatic man show an ill-defined mixed GGN located in the right lower lobe. (D) The solid component in this nodule significantly increases after one month.