CTICasesDisseminated Blastomycosis presenting as Miliary Pattern
Imaging findings
Serial CT chest scans in a 44-year-old female show a miliary pattern of tiny 1-2 mm nodules, which evolved into a sandstorm appearance. A follow-up CT two months later shows regression of nodules but development of traction bronchiectasis and volume loss (NSIP-like organizing DAD).
Key takeaways
Blastomycosis typically presents as lobar consolidation, but hematogenous dissemination can lead to a miliary pattern. As the acute lung injury resolves, it can organize into a pattern mimicking NSIP with bronchovascular fibrosis and volume loss.
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