CTICasesCoccidioidomycosis
Imaging findings
Chest CT in a patient presenting with fever and weight loss demonstrates bulky, necrotic, and asymmetric subcarinal and left hilar lymphadenopathy that causes deviation and narrowing of the left lower lobe bronchus. Multiple ill-defined, solid pulmonary nodules with surrounding ground-glass halos are present in both lower lobes. Biopsy of a node confirms Coccidioides immitis infection, showing spherules filled with endospores.
Key takeaways
Coccidioidomycosis can present with bulky, necrotic mediastinal lymphadenopathy and pulmonary nodules that mimic lymphoma, sarcoidosis, or lung carcinoma. The asymmetry of the adenopathy, presence of necrotic centers, and pulmonary nodules with ground-glass halos (representing hemorrhage) help steer the diagnosis toward coccidioidomycosis, which is confirmed histologically by identifying Coccidioides spherules.
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