CTICasesDisseminated Blastomycosis
Imaging findings
Serial chest radiographs and CT scans demonstrate a background of progressive massive fibrosis and coalescing nodular pseudo-plaques typical of advanced silicosis. Superimposed on this chronic lung disease, new features include a small pleural effusion and multiple discrete, sub-segmental cavitating and non-cavitating pulmonary nodules, including a larger mass-like nodule at the right lung base containing calcifications.
Key takeaways
Blastomycosis can present atypically with pleural involvement and discrete nodules rather than a solid mass or lobar consolidation, particularly when superimposed on pre-existing structural lung disease like silicosis. A detailed physical examination may reveal characteristic cutaneous ulcerations, confirming disseminated disease, which requires prompt systemic antifungal treatment.
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