CTICasesCoccidioidomycosis Mimicking Lung Cancer
Imaging findings
An asymptomatic man in his 60s with a multinodular goiter and hepatitis E had an incidentally noted right lower lobe mass-like consolidation with mildly enlarged subcarinal and right hilar nodes. Over a month, follow-up CT showed the area enlarged and enhancing with an enlarged subcarinal node, raising concern for cancer. Bronchoscopic biopsy of the subcarinal and level 11 nodes showed yeast forms that grew coccidioides, and the findings improved on fluconazole.
Key takeaways
Coccidioidomycosis can present as an enlarging mass-like consolidation with mildly hyperemic lymph nodes that closely mimics lung cancer, even in an asymptomatic patient. Yeast forms on nodal sampling and culture establish the diagnosis, treatment is with fluconazole, and residual disease that never fully resolves is common.
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