CTICasesPulmonary Nocardiosis
Imaging findings
Contrast-enhanced chest CT in a lung transplant recipient reveals an irregular, fairly compact, non-aggressive soft tissue nodule above the left hilum and aortic arch containing an internal air bronchogram. Accompanying findings include a moderate left pleural effusion and dense, patchy consolidation in the left lung base.
Key takeaways
Nocardiosis is an opportunistic bacterial infection caused by Nocardia species that frequently affects immunocompromised hosts, particularly solid organ transplant recipients (kidney, heart, liver, lung). Radiographically, it commonly presents as single or multiple pulmonary nodules or masses, often with air bronchograms or central cavitation, mimicking fungal infections like aspergillosis or cryptococcosis, as well as post-transplant lymphoproliferative disorder (PTLD). Because these entities are radiologically indistinguishable, tissue biopsy or bronchoalveolar lavage is mandatory for definitive microbiological diagnosis to guide targeted, long-term antibiotic therapy.
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