ARRS 2022 Abstracts


E1983. Imaging Findings in Treatment-Resistant Disseminated Coccidioidomycosis
  1. Gianna DiGrazia; Loyola University Medical Center
  2. Joseph Kus; Loyola University Medical Center
  3. Mariah Bashir ; Loyola University Medical Center
Coccidioidomycosis is a fungal disease endemic to the southwestern United States, Mexico, and Central and South America. The incidence of reported disease in endemic and non-endemic areas is rising, related to a more mobile society. The disease is caused by inhalation of spores of Coccidioides species, leading to higher risk in people exposed to frequent soil aerosolization. The diagnosis is established by either direct visualization of mature spherules in culture or by serologic testing of anti-Coccidioides antibodies. The infection is self-limited in 60% of cases, and disseminated disease occurs in less than 1% of patients. There is an array of imaging findings in disseminated coccidioidomycosis, including predominantly pulmonary and musculoskeletal manifestations. It is important for radiologists to recognize these imaging features, especially in non-endemic areas, to keep a high index of suspicion of this rare but insidious disease.

Educational Goals / Teaching Points
The goal of this educational exhibit is the discuss the causal organism, epidemiology, CT, and MRI findings and treatment of disseminated coccidioidomycosis. The progression of pulmonary and skeletal imaging manifestations in treatment-resistant disseminated coccidioidomycosis will be highlighted.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
CT findings of disseminated pulmonary coccidioidomycosis include miliary nodules from hematogenous spread that can progress to confluent opacities. Additional findings in the chest include pleural effusions and mediastinal adenopathy. Extrapulmonary manifestations of coccidioidomycosis can be seen in the skin, lymph nodes, bones, and joints. CT and MRI findings in the spine include extensive bony destruction and paraspinal phlegmon/abscesses, with potential for spinal canal stenosis.

The incidence of coccidioidomycosis is increasing in both endemic and non-endemic regions. There is a wide spectrum of pulmonary and extrapulmonary manifestations that demonstrate nonspecific imaging characteristics. A thorough understanding of the epidemiology and constellation of imaging findings in coccidioidomycosis is necessary for radiologists to make a prompt diagnosis and avoid treatment delays.