Abstracts

RETURN TO ABSTRACT LISTING


E1736. Thoracoabdominal Ganglionic Paracoccidiodomycosis: A Case-Based Review
Authors
  1. Lucas Junqueira; Faculdade de Medicina de Jundiai; Hospital Sao Vicente de Paulo
  2. Waldinei Rodrigues; Faculdade de Medicina de Jundiai; Hospital Sao Vicente de Paulo
  3. Olivia Pião; Faculdade de Medicina de Jundiai; Hospital Sao Vicente de Paulo
  4. Lais Bertoche; Faculdade de Medicina de Jundiai; Hospital Sao Vicente de Paulo
  5. Renan Possari; Faculdade de Medicina de Jundiai; Hospital Sao Vicente de Paulo
  6. Dana Codreanschi; Faculdade de Medicina de Jundiai; Hospital Sao Vicente de Paulo
  7. Marlon Vieira; Faculdade de Medicina de Jundiai; Hospital Sao Vicente de Paulo
Background
Paracoccidioidomycosis is a fungal, chronic granulomatous infectious disease that mainly affects the lungs, with the potential to spread to other organs, notably the lymphatic system and the skin. Imaging methods, mainly computed tomography, play an important role in the evaluation of the lungs and lymph node systems, which are the organs most affected by the disease. In addition, the radiologist monitors and evaluates differential diagnoses. As it is not a mandatory reporting disease, the prevalence, incidence and mortality data are uncertain. According to the non-service reference services for cases of paracoccidioidomycosis, it is believed that their service in endemic areas varies from 3 to 4 new cases / million inhabitants.

Educational Goals / Teaching Points
Carry out a review of the main imaging findings, such as focus on computed tomography, of the infection of paraccocidiodomycosis that the radiologist needs to know. Discuss the main differential diagnoses of thoracic and abdominal lymph node enlargement, such as lymphoproliferative diseases and disseminated tuberculosis. Present a case report of an immunocompetent young adult with thoracic and abdominal lymph node enlargement, without involvement of the lung parenchyma.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The main etiologic agent is Paracoccidioides brasiliensis. Its natural habitat is the soil and its infection is caused by inhalation of conidia. Its clinical presentations can be divided into acute and subacute forms, which occur mainly in children and preferentially affect the skin and lymphatic system, and chronic, which occurs notably in adults, particularly the lung. The gold standard for the diagnosis of paracoccidiodomycosis is the finding of fungal elements of Paracoccidioides brasiliensis in a fresh examination of sputum or another specimen (lymph node aspirate). The main organ affected is the lung, being involved in about 50-100%, 80% as an active disease and 60% as fibrotic lesions. Second, there is lymph node involvement, especially in the cervical, supraclavicular, axillary chains and, more rarely, abdominal involvement.

Conclusion
Pulmonary involvement is the main radiological manifestation of paracoccidiodomycosis, but the primary involvement of the lymphatic system is relatively common in the acute phase, with regional or diffuse lymph node enlargement, with cervical chains being the most affected, followed by supraclavicular, axillary and abdominal. This ringworm is an important public health problem and the recognition of unusual forms is essential for adequate treatment, avoiding high potential for morbidity and mortality.