PMC7289762_01
Axial image from a CT scan of the chest set to lung window showing a solid 11mm nodule in the right lower lobe behind the diaphragm.
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Chest CT performed five months after the abdominal study revealed an increase in size of the solid RLL PN to 11mm (Fig. 1) along with mediastinal and right hilar lymph nodes all measuring less than 1cm in short axis.
Histological section of lung tissue obtained at surgery and stained with Gomori methenamine silver highlights the presence of small yeast forms, some exhibiting narrow-based budding (black arrows) characteristic of H. capsulatum (original magnification x 400).
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Tissue examination revealed necrotizing granulomatous inflammation associated with small yeast-like forms exhibiting narrow-based budding, morphologically consistent with H. capsulatum (Fig. 2).
PMC7289762_02
A, Axial image from the CT portion of a18FDG-PET/CT study set to lung window showing a spherical, solid 1.2cm subpleural nodule in the right lower lobe. The nodule's maximal standardized uptake value on the PET portion (not shown) was 2.33. B, Axial image from the CT portion of a18FDG-PET/CT study obtained 12 months later than the one in panel A showing a similarly sized nodule but with interval development of cavitation. The maximal standardized uptake value on the PET portion (not shown) now measured 5.18.
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Preoperatively, 18FDG-PET/CT revealed a 1.2cm hypermetabolic RLL PN with a maximal standardized uptake ratio (SUVmax) of 2.3 (Fig. 3A). On repeat 18FDG-PET/CT one year after the initial study, the PN was not appreciably changed in size but now had a cavitary appearance with an increase in SUVmax to 5.18 (Fig. 3B).
PMC7289762_03
A, Frontal chest radiograph showing a dense consolidation in the left upper lobe. B, Axial image from a CT scan of the chest set to lung window demonstrating the consolidation to be located in the apicoposterior segment of the left upper lobe. A small focus of cavitation (black arrow) is evident within the consolidation.
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His chest radiograph revealed a dense left upper lobe (LUL) consolidation (Fig. 4A). Chest CT illustrated the same finding with no additional abnormalities present (Fig. 4B).
Section of cell block prepared from the bronchoalveolar lavage fluid cytology specimen and stained with Gomori methenamine silver showing a representative fungal form of relatively large size that exhibits broad-based budding, making it morphologically consistent with B. dermatitidis (original magnification x 400).
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Rare fungal forms were visualized in the BAL fluid cytology specimen stained with Gomori methenamine silver (Fig. 5).