Fang Wayne, Washington Lacey, Kumar Nidhi
Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA.
Radiographics. 2007 May-Jun;27(3):641-55. doi: 10.1148/rg.273065122.
Pulmonary blastomycosis is an uncommon pathologic condition that is endemic to Canada and the upper Midwest of the United States. Blastomycosis has a variety of radiologic manifestations, including airspace consolidation, focal masses, intermediate-sized nodules, interstitial disease, miliary disease, and cavitary lesions. Affected patients may be asymptomatic or may present with clinical manifestations ranging from mild chronic cough to acute respiratory distress syndrome-like symptoms. Patients with acute symptoms are more likely to have airspace consolidation, whereas chronic manifestations may be associated with masslike lesions. Intermediate-sized nodules with accompanying airspace consolidation, particularly in the upper lobes, should raise suspicion for fungal disease. Lymphadenopathy and pleural effusions are quite uncommon, and calcification is not often seen. Blastomycosis may be aggressive and require treatment. Dissemination from the lung is not unusual and can involve any organ. Diagnosis is often delayed because blastomycosis can mimic many other disease processes, including bacterial pneumonia, malignancy, and tuberculosis. Radiologists can best contribute to the care of patients who live or travel in endemic areas by maintaining a high degree of suspicion for blastomycosis and being familiar with its myriad manifestations.
肺芽生菌病是一种不常见的病理状况，在加拿大和美国中西部上游地区呈地方性流行。芽生菌病有多种放射学表现，包括肺泡实变、局灶性肿块、中等大小结节、间质性病变、粟粒性病变和空洞性病变。受影响的患者可能无症状，或可能出现从轻度慢性咳嗽到急性呼吸窘迫综合征样症状不等的临床表现。有急性症状的患者更可能出现肺泡实变，而慢性表现可能与肿块样病变有关。伴有肺泡实变的中等大小结节，特别是在上叶，应引起对真菌病的怀疑。淋巴结病和胸腔积液相当少见，钙化也不常出现。芽生菌病可能具有侵袭性，需要治疗。从肺部播散并不罕见，可累及任何器官。诊断往往会延迟，因为芽生菌病可模仿许多其他疾病过程，包括细菌性肺炎、恶性肿瘤和结核病。放射科医生通过对芽生菌病保持高度怀疑并熟悉其众多表现，可为生活在或前往流行地区的患者的护理做出最大贡献。
