CTICasesCoccidioidomycosis Rib Osteomyelitis
Imaging findings
Chest radiographs in a 22-year-old African-American man show a hazy asymmetry in the left hemithorax and right hilar lymphadenopathy. Chest CT demonstrates a large, necrotic soft-tissue chest wall mass associated with osteolytic destruction of the adjacent left anterior rib, which directly abuts the right ventricle. Necrotic mediastinal lymph nodes and diffuse miliary pulmonary nodules are present. Biopsy of the rib mass confirms Coccidioides immitis infection.
Key takeaways
Coccidioidomycosis is a fungal infection endemic to the southwestern United States. While usually presenting as a self-limited pulmonary infection, disseminated disease can occur, particularly in African-American and Filipino individuals. Disseminated coccidioidomycosis can cause osteomyelitis, frequently involving the ribs, skull, or spine. This presents as osteolytic bone destruction and large, necrotic cold abscesses that can mimic bone malignancies like Ewing's sarcoma.
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