CTICasesBlastomycosis Presenting as Large Nodules with Air Bronchograms
Imaging findings
A 77-year-old with cough and fever has ill-defined nodules in both lungs on radiographs, with old right-sided traumatic change but no pleural abnormality. CT the same day shows numerous nodules and a large mass with slight cavitation, several of the nodules containing air bronchograms. Mediastinal nodes are present but only modestly enlarged, and there is no pleural effusion or pleural reaction.
Key takeaways
Air bronchograms running through nodules usually direct thinking toward lymphoma among the neoplasms, but the clinical picture of fever and cough favoured infection, and bronchoscopy proved blastomycosis. This is an unusual manifestation: blastomycosis is more familiar as tiny nodules, or as a consolidative mimic of community-acquired pneumonia, in which form air bronchograms are in fact common. Cavitation occurs reasonably often. The combination of only modest lymphadenopathy with an absent pleural reaction is a useful pointer toward blastomycosis.
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