Computed tomography (CT) and positron emission tomography with [F]fluoro-2-deoxy-d-glucose (FDG-PET) images of pulmonary cryptococcosis mimicking lung cancer

BACKGROUND: The objective of this study was to clarify the clinical features of pulmonary cryptococcosis using chest computed tomography (CT) and positron emission tomography with 18F]fluoro-2-deoxy-D-glucose (FDG-PET), with a view to developing appropriate treatment. METHODS: We analyzed the clinical features, and chest CT and FDG-PET characteristics of six cases of pulmonary cryptococcosis that were treated by surgery. The patients comprised four males and two females, ranging in age from 28 to 79 years. RESULTS: All the patients were asymptomatic and had no extrapulmonary involvement. In all cases, chest CT showed nodular shadows. Spiculation and convergence of peripheral vessels were demonstrated in three cases, and pleural indentation in two cases. FDG-PET was performed in four of the cases, and showed accumulation of FDG in all of them. The standard uptake value (SUV) ranged from 0.93 to 4.85. Chest CT findings and accumulation of FDG made it difficult to distinguish pulmonary cryptococcosis from malignancies. Segmentectomy or wedge resection was performed in all cases for pathological diagnosis, and this revealed Cryptococcus fungal bodies. After surgical resection, no sign of relapse has been seen in any of the patients. CONCLUSIONS: Surgical resection is recommended for both diagnosis and treatment of pulmonary cryptococcosis.