CTICasesPseudallescheria boydii Mycetoma
Imaging findings
Chest CT in a patient with cystic fibrosis shows bilateral, massive fungus balls (mycetomas) occupying pre-existing apical bronchiectatic cavities, presenting with a prominent air-crescent sign (Monod sign). Cultures of the sputum and cavities speciate as Pseudallescheria boydii (Scedosporium apiospermum).
Key takeaways
Pseudallescheria boydii (the asexual form is Scedosporium apiospermum) is a filamentous fungus that can colonize pre-existing lung cavities (such as bronchiectasis in cystic fibrosis or tuberculous cavities), forming mycetomas. P. boydii is morphologically identical to Aspergillus on imaging and histology, but is clinically important to distinguish because it is inherently resistant to amphotericin B.
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