Pathoradiologic correlation of pulmonary candidiasis in immunosuppressed patients.

The diagnosis of pulmonary candidiasis can only be made with certainty when tissue invasion by the organism is demonstrated histologically. In order to ascertain whether characteristic radiographic patterns are seen in patients with pulmonary candidiasis, antemortem radiographic abnormalities were correlated with autopsy findings in 25 immunosuppressed patients who had histoinvasive pulmonary candidiasis. Pathological analysis enabled division of patients by route of infection into hematogenous and endobronchial groups, characterized by disseminated nodules and patchy bronchopneumonia, respectively. However, no specific radiographic patterns emerged in either patient group due to the small size of lesions and the high frequency of other pulmonary infections, edema, and hemorrhage. Since the radiographic patterns described for other opportunistic fungi do not appear to apply to this organism, a decision to institute antifungal therapy should not await evolution of radiographic changes.