a Department of Radiology , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil.
b Cardiothoracic Consultant and Intervention , Liverpool Heart and Chest Hospital , Liverpool , UK.
Expert Rev Respir Med. 2019 Mar;13(3):263-277. doi: 10.1080/17476348.2019.1571914. Epub 2019 Jan 31.
Systemic endemic mycoses are prevalent in specific geographical areas of the world and are responsible for high rates of morbidity and mortality in these populations, and in immigrants and travelers returning from endemic regions. The most common fungal infections that can affect the lungs of immunocompetent patients include histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis, sporotrichosis, aspergillosis, and cryptococcosis. Diagnosis and management of these diseases remain challenging, especially in non-endemic areas due to the lack of experience. Therefore, recognition of the various radiologic manifestations of pulmonary fungal infections associated with patients' clinical and epidemiologic history is imperative for narrowing the differential diagnosis. Areas covered: This review discusses the clinical and radiological findings of the main endemic fungal diseases affecting the lungs in immunocompetent patients. Specific topics discussed are their etiology, epidemiology, pathogenesis, clinical manifestations, methods of diagnosis, pathology and main imaging findings, especially in computed tomography. Expert commentary: Imaging plays an important role in the diagnosis and management of pulmonary fungal infection and may reveal useful signs. Although definitive diagnosis cannot be made based on imaging features alone, the use of a combination of epidemiologic, clinical and imaging findings may permit the formulation of an adequate differential diagnosis.
系统性地方性真菌病在世界特定地理区域流行，这些地区的人群发病率和死亡率较高，移民和从流行地区返回的旅行者也是如此。最常见的可影响免疫功能正常患者肺部的真菌感染包括组织胞浆菌病、球孢子菌病、副球孢子菌病、芽生菌病、孢子丝菌病、曲霉病和隐球菌病。由于缺乏经验，这些疾病的诊断和管理仍然具有挑战性，尤其是在非流行地区。因此，认识与患者临床和流行病学史相关的肺部真菌感染的各种放射学表现对于缩小鉴别诊断范围至关重要。涵盖领域：本文综述了影响免疫功能正常患者肺部的主要地方性真菌病的临床和放射学表现。讨论的具体主题包括其病因、流行病学、发病机制、临床表现、诊断方法、病理学和主要影像学表现，尤其是在计算机断层扫描中。专家评论：影像学在肺部真菌感染的诊断和管理中起着重要作用，可能揭示有用的征象。虽然不能仅根据影像学特征做出明确诊断，但结合流行病学、临床和影像学表现可能有助于制定充分的鉴别诊断。
