CTICasesPulmonary Nocardiosis in a Lung Transplant Recipient
[...]. Pulmonary Nocardiosis in a Lung Transplant Recipient. CTICases. Published September 11, 2026. https://cticases.com/c/75dq4
Imaging findings
A lung transplant recipient who had been doing well developed a cough and was scanned at a low threshold. CT showed a new mass in the posterior right upper lobe with at least one satellite nodule, extending inferiorly across the fissure into the lower lobe. Sagittal reformats showed a rim of ground glass surrounding the mass, a halo sign. Background pleural thickening with tethering was present but longstanding, a common finding in this population and distinct from the new lesion. Transbronchial biopsy established nocardiosis.
Key takeaways
A masslike consolidation with a ground glass halo in an immunosuppressed patient is usually attributed to angioinvasive fungal infection, but Nocardia deserves a permanent place alongside Aspergillus in that differential, particularly in transplant recipients. Nocardia is a filamentous branching aerobic actinomycete, a bacterium that behaves on imaging like a fungus, and although it sits in the same group as Actinomyces it is far more aggressive and disseminates readily. Imaging cannot separate these organisms, so a low threshold for bronchoscopic sampling is what makes the diagnosis.
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