Infection and Drug Resistance (Oct 2022)
Clinical and Computed Tomography Characteristics of Solitary Pulmonary Nodules Caused by Fungi: A Comparative Study
Abstract
Jin Jiang,1,* Zhuo-ma Lv,1,2,* Fa-jin Lv,1 Bin-jie Fu,1 Zhang-rui Liang,1 Zhi-gang Chu1 1Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Radiology, The Second People’s Hospital of Yubei District, Chongqing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhi-gang Chu, Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong district, Chongqing, 400016, People’s Republic of China, Tel +86 18723032809, Fax +86 23 68811487, Email [email protected]: To clarify the clinical and computed tomography (CT) indicators in distinguishing pulmonary nodules caused by fungal infection from lung cancers.Methods: From January 2013 to April 2022, 68 patients with solitary fungal nodules (64 were solid and 4 were mixed ground-glass nodules) and 140 cases with solid cancerous nodules with similar size were enrolled. Their clinical characteristics and CT manifestations of the solid nodules were summarized and compared, respectively.Results: Compared with patients with lung cancers, cases were younger (51.2 ± 11.5 vs 61.3 ± 10.2 years) and non-smokers (72.1% vs 57.9%) and immunocompromised (44.1% vs 17.9%) individuals were more common in patients with fungal nodules (each P < 0.05). The air crescent sign (ACS) (34.4% vs 0%), halo sign (HS) (23.4% vs 4.3%), and satellite lesions (45.3% vs 2.9%) were more frequently detected in fungal nodules than in cancerous ones (each P < 0.05). Air bronchogram similarly occurred in fungal and cancerous nodules, whereas the natural ones were more common in the former (100% vs 16.7%, P = 0.000). However, the fungal nodules had a lower enhancement degree (29.0 ± 19.2 HU vs 40.3 ± 28.3 HU, P = 0.038) and frequency of hilar and/or mediastinal lymph node enlargement (2.9% vs 14.3%, P = 0.013) compared with the cancerous nodules.Conclusion: In the younger, non-smoking and immunocompromised patients, a solitary pulmonary solid nodule with ACS, HS, satellite lesions and/or natural air bronchogram but without significant enhancement, fungal infection is a probable diagnosis.Keywords: tomography, X-ray computed, pulmonary nodules, fungal infection
