Department of Radiology, University of California Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA.
BMC Infect Dis. 2022 Jul 17;22(1):623. doi: 10.1186/s12879-022-07601-1.
Pericardial disease can be a manifestation of infection and imaging can have a role in its diagnosis. coccidioidomycosis endemic fungal infection has been more frequently reported over the past few decades. Other than case reports or series, there has been no systemic study evaluating pericardial imaging findings in patients with coccidioidomycosis to the best of our knowledge. The purpose of this study was to evaluate intrathoracic computed tomographic (CT) imaging abnormalities in patients with coccidioidal infection with specific emphasis on the pericardium.
Retrospective review of radiology reports and clinical chart review was performed to identify patients with coccidioidomycosis between January 2000 and September 2021 at our medical center. Diagnosis of infection was confirmed predominately with serology. Patients were excluded if a CT was not performed within 3 months of confirmed diagnosis date and if there was concomitant additional granulomatous or fungal infection. Chest CT was reviewed for pericardial and additional intrathoracic findings.
The final retrospective cohort consisted of 37 patients. Imaging findings included lung nodules (N = 33/37), consolidation (N = 25/37), mediastinal or hilar lymphadenopathy (N = 20/37) and pleural effusions (N = 13/37). Eleven of 37 patients (30%) had either trace pericardial fluid (N = 3/37) or small pericardial effusions (N = 8/37). One patient had pericardial enhancement/thickening and history of pericardial tamponade. No other patient had clinical pericarditis or pericardial tamponade. Pericardial calcifications were not seen in any patient. Pericardial effusion was statistically associated with presence of pleural effusion as 9/13 patients with pleural effusion had pericardial effusion versus 2/26 patients without pleural effusion had pericardial effusion (p < 0.001). Otherwise patients with and without pericardial imaging findings were similar in terms of demographics, comorbidities and other imaging findings.
Pulmonary parenchymal pathology is a common manifestation of coccidioidal infection. Most patients with coccidioidomycosis do not have pericardial imaging abnormalities on CT.
心包疾病可能是感染的一种表现，影像学检查在其诊断中具有一定作用。地方性真菌感染球孢子菌病在过去几十年中被更频繁地报道。据我们所知，除了病例报告或系列病例外，尚无系统研究评估球孢子菌病患者的心包影像学表现。本研究旨在评估患有球孢子菌感染的患者的胸部计算机断层扫描（CT）影像学异常，重点关注心包。
对 2000 年 1 月至 2021 年 9 月期间在我们医疗中心确诊为球孢子菌病的患者的放射学报告和临床病历进行回顾性审查。感染的诊断主要通过血清学确认。如果 CT 检查不在确诊日期后的 3 个月内进行，或者存在合并的其他肉芽肿或真菌感染，则排除患者。对胸部 CT 进行心包和其他胸部影像学表现的回顾性分析。
最终的回顾性队列包括 37 名患者。影像学表现包括肺结节（N=33/37）、实变（N=25/37）、纵隔或肺门淋巴结肿大（N=20/37）和胸腔积液（N=13/37）。37 名患者中有 11 名（30%）存在微量心包积液（N=3/37）或少量心包积液（N=8/37）。1 名患者有心包增强/增厚和心包填塞病史。其他患者均无心包炎或心包填塞的临床症状。没有患者有心包钙化。9/13 名胸腔积液患者存在心包积液，而 2/26 名无胸腔积液患者存在心包积液（p<0.001），心包积液与胸腔积液的存在显著相关。否则，心包影像学表现存在或不存在的患者在人口统计学特征、合并症和其他影像学表现方面相似。
肺部实质病理学是球孢子菌感染的常见表现。大多数球孢子菌病患者的 CT 心包影像学无异常。
