From the Department of Clinical Radiology, University of Missouri-Columbia, 1 Hospital Dr, Columbia, MO 65212 (J.R.K., A.H.); Department of Radiology, University of Southern California, Los Angeles, Calif (L.F.B.); Departments of Diagnostic Radiology (C.F.) and Pathology (D.S.), Oregon Health Sciences & University, Portland, Ore; and Department of Diagnostic Radiology, University of Kansas Medical Center, Kansas City, Kan (C.M.W.).
Radiographics. 2021 Mar-Apr;41(2):380-398. doi: 10.1148/rg.2021200071. Epub 2021 Feb 5.
The digitization of radiographic studies along with high-speed transmission of images has formed the basis of teleradiology, which has become an integral component in the workflow of a contemporary radiology practice. It is with this advent and growing utilization of teleradiology that the significance of the source location of images has gained importance. Specifically, the importance of where the patient resides and what endemic fungi occur in that location cannot be underestimated. In the United States, histoplasmosis, coccidioidomycosis, blastomycosis, and cryptococcosis are caused by endemic fungi occurring in the Ohio and Mississippi river valleys, the Southwest, the Upper Midwest, and the Pacific Northwest, respectively. All of these organisms enter the body through the respiratory system and have the potential to cause significant morbidity and mortality. Patients infected with these fungi are often asymptomatic but may present with acute flulike symptoms such as fever, cough, or dyspnea. Patients may also present with vague chronic symptoms including cough, fever, malaise, and weight loss. Thoracic manifestations at radiography and CT include consolidation, nodules, cavities, lymphadenopathy, and pleural disease. PET may show fluorine 18-fluorodeoxyglucose uptake with active acute or chronic infections, and it is difficult to distinguish infections from malignancy. Imaging findings may be nonspecific and can be confused with other disease processes, including malignancy. The patient demographics, clinical history, and location are clues that may lead to a proper diagnosis of endemic fungal disease. The radiologist should be cognizant of the patient location to provide a correct and timely radiologic diagnosis that helps guide the clinician to initiate appropriate therapy. RSNA, 2021.
放射学研究的数字化以及图像的高速传输构成了远程放射学的基础，远程放射学已经成为当代放射学实践工作流程的一个组成部分。正是由于远程放射学的出现和日益普及，图像的来源位置的重要性变得越来越重要。具体来说，患者所在地以及该地区存在哪些地方性真菌的重要性不容忽视。在美国，组织胞浆菌病、球孢子菌病、芽生菌病和隐球菌病分别由俄亥俄州和密西西比河流域、西南部、中西部北部和太平洋西北部的地方性真菌引起。所有这些病原体都通过呼吸系统进入人体，有可能导致严重的发病率和死亡率。感染这些真菌的患者通常无症状，但可能出现急性流感样症状，如发热、咳嗽或呼吸困难。患者也可能出现模糊的慢性症状，包括咳嗽、发热、不适和体重减轻。放射摄影和 CT 上的胸部表现包括实变、结节、空洞、淋巴结病和胸膜疾病。PET 可能显示氟 18-氟脱氧葡萄糖摄取，具有急性或慢性活动性感染，并且难以将感染与恶性肿瘤区分开来。影像学表现可能不具有特异性，并且可能与其他疾病过程混淆，包括恶性肿瘤。患者的人口统计学、临床病史和位置是可能导致地方性真菌病正确诊断的线索。放射科医生应该了解患者的位置，以便提供正确和及时的放射学诊断，帮助临床医生开始适当的治疗。RSNA，2021 年。
