CTICasesDisseminated Coccidioidomycosis Mimicking Metastatic Cancer
Imaging findings
A Cantonese-speaking man who immigrated from an endemic region several years earlier presents with weight loss and subjective fevers. Chest radiograph shows right paratracheal widening with adjacent right upper lobe abnormality; CT shows centrally necrotic right paratracheal lymph nodes contiguous with the lung lesion, plus a rim-enhancing chest-wall mass invading the sternum along the sternocleidomastoid muscle belly. Neck and spine CT show near-complete destruction of the C1-C2 vertebral bodies and additional lytic lesions in the lumbar spine and pelvis.
Key takeaways
Multifocal necrotic lymphadenopathy, chest-wall invasion, and destructive osseous lesions mimicking metastatic lung cancer instead proved to be disseminated coccidioidomycosis on sternal biopsy -- endemic fungal infection should be kept on the differential for apparent metastatic disease in any patient with residence history in the coccidioidomycosis-endemic southwestern United States, since such histories can be remote and easily overlooked.
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