CTICasesPulmonary Coccidioidomycosis with Subclavian Artery Occlusion and Brachial Plexus Involvement
Imaging findings
Chest CT shows a large cavitary lesion with an air-fluid level and thick wall in the left upper lobe, which extends superiorly through the thoracic inlet. CT angiography and catheter angiography demonstrate severe narrowing of the left subclavian artery, which is encased by the apical inflammatory mass. The lungs show diffuse tree-in-bud nodularity and centrilobular nodules.
Key takeaways
Coccidioidomycosis (valley fever) can cause chronic, progressive, necrotizing pulmonary infections that mimic squamous cell carcinoma or tuberculosis. When located in the lung apex, a large coccidioidal abscess can extend beyond the pleural cavity into the thoracic inlet, resulting in vascular complications like subclavian artery stenosis/occlusion and neurological symptoms due to brachial plexus involvement.
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