From the Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 800 Vila Clementino, São Paulo, SP, Brazil 04024-002 (M.C.A., J.B.P., V.N.S., L.K.M., D.T.K., A.d.A.e.C., A.R.C.F., A.Y.A.); Department of Radiology, Hospital das Clínicas da Faculdade de Medicina de Marília, Marília, São Paulo, Brazil (M.C.A.); Department of Radiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY (J.T.B.); Department of Diagnostic Imaging, Laboratório Delboni, DASA, São Paulo, Brazil (J.B.P., V.N.S., L.K.M., D.T.K., A.Y.A.); Department of Radiology, Hospital do Coração, HCor and Teleimagem, São Paulo, Brazil (V.N.S.); Department of Infectious Diseases, Universidade Federal de São Paulo, São Paulo, Brazil (A.M.D.); Hospital Israelita Albert Einstein, São Paulo, Brazil (A.d.A.e.C.); and Department of Radiology, Grupo de Radiologia e Diagnóstico por Imagem-Rede D'Or, São Paulo, Brazil (A.R.C.F.).
Radiographics. 2024 Jul;44(7):e230176. doi: 10.1148/rg.230176.
Fungal musculoskeletal infections often have subacute or indolent manifestations, making it difficult to distinguish them from other diseases and infections, given that they are relatively uncommon. Fungal infections occur by hematogenous spread, direct inoculation, or contiguous extension and may be related to different risk factors, including immunosuppression and occupational activity. The infection can manifest in isolation in the musculoskeletal system or as part of a systemic process. The fungi may be endemic to certain regions or may be found throughout the world, and this can help to narrow the diagnosis of the etiologic agent. Infections such as candidiasis, cryptococcosis, aspergillosis, and mucormycosis are often related to immunosuppression. On the other hand, histoplasmosis, paracoccidioidomycosis, coccidioidomycosis, and blastomycosis can occur in healthy patients in geographic areas where these infections are endemic. Furthermore, infections can be classified on the basis of the site of infection in the body. Some subcutaneous infections that can have osteoarticular involvement include mycetoma, sporotrichosis, and phaeohyphomycosis. Different fungi affect specific bones and joints with greater prevalence. Imaging has a critical role in the evaluation of these diseases. Imaging findings include nonspecific features such as osteomyelitis and arthritis, with bone destruction, osseous erosion, mixed lytic and sclerotic lesions, and joint space narrowing. Multifocal osteomyelitis and chronic arthritis with joint effusion and synovial thickening may also occur. Although imaging findings are often nonspecific, some fungal infections may show findings that aid in narrowing the differential diagnosis, especially when they are associated with the patient's clinical condition and history, the site of osteoarticular involvement, and the geographic location. RSNA, 2024.
真菌性肌肉骨骼感染常呈亚急性或慢性表现，由于其相对少见，因此很难将其与其他疾病和感染区分开来。真菌感染可通过血行播散、直接接种或直接蔓延引起，可能与不同的危险因素有关，包括免疫抑制和职业活动。感染可单独发生在肌肉骨骼系统，也可作为全身过程的一部分。真菌可能是某些地区的地方性的，也可能在世界各地都有，这有助于缩小病因的诊断范围。念珠菌病、隐球菌病、曲霉病和毛霉病等感染通常与免疫抑制有关。另一方面，组织胞浆菌病、球孢子菌病、球孢子菌病和芽生菌病可发生在免疫功能正常的患者中，这些感染在这些地区流行。此外，感染还可以根据感染在体内的部位进行分类。一些可能涉及骨和关节的皮下感染包括真菌性骨脓肿、孢子丝菌病和暗色丝孢霉病。不同的真菌对特定的骨骼和关节有更高的患病率。影像学在这些疾病的评估中具有关键作用。影像学表现包括非特异性特征，如骨髓炎和关节炎，表现为骨质破坏、骨侵蚀、混合溶骨性和硬化性病变以及关节间隙变窄。多灶性骨髓炎和慢性关节炎伴关节积液和滑膜增厚也可能发生。尽管影像学表现通常是非特异性的，但一些真菌感染可能表现出有助于缩小鉴别诊断的特征，尤其是当它们与患者的临床状况和病史、骨和关节受累的部位以及地理位置相关时。RSNA，2024 年。
