CTICasesDisseminated Coccidioidomycosis
Imaging findings
Chest radiograph reveals a subtle, asymmetric opacity in the right lung apex. Contrast-enhanced CT confirms a mass-like lesion in the right lung apex showing internal necrosis/cavitation and multiple surrounding, small satellite nodules, as well as adjacent bronchial wall thickening.
Key takeaways
A mass-like pulmonary lesion with satellite nodules in a patient presenting with altered mental status should prompt suspicion for disseminated granulomatous infection rather than primary lung cancer. Coccidioidomycosis can present as a cavitary apical mass with satellite nodules, representing the primary pulmonary portal for hematogenous dissemination to the meninges (coxy meningitis).
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