Keywords:
Lung, CT, CT-High Resolution, Biopsy, Statistics, Infection, Inflammation
Authors:
C. V. D. Oliveira1, H. Lee1, N. Horvat1, L. D. A. Testagrossa1, D. ROMÃO2, M. B. Rassi2, C. B. F. Leite1, G. G. Cerri2; 1Sao Paulo/BR, 2SÃO PAULO/BR
DOI:
10.26044/ecr2019/C-1705
Conclusion
Despite considered a high TB burden country by World Health Organization [8],
in our study,
held in one single tertiary hospital located in Sao Paulo,
Brazil,
Histoplasma infection was more frequent than tuberculosis among biopsy proven GLD.
Mukhopadhyay et al [9] reviewed the causes of GLD in 7 different countries,
including Brazil.
On this study population,
tuberculosis occurred in 13 of 50 cases of GLD from Brazil (26.0%),
and none of the Brazilian cases was due to histoplasmosis,
which was diagnosed exclusively in the USA.
The study of Nazarullah et al [10] reviewed GLD diagnosed in a single institution in San Antonio,
Texas,
and also demonstrated predominance of mycobacterial infection,
with nearly half classified as non-tuberculous mycobacteria.
One possible reason for the significant difference in the incidence of mycobacterial infection in our study population might be the fact that samples other than lung biopsy,
such as sputum or bronchoalveolar lavage,
were not included in our study.
It also suggests that possibly only minority of cases of tuberculosis and other mycobacteriosis have been diagnosed by lung biopsy.
Centrilobular micronodules and cavitation are typical imaging features of tuberculosis and were significantly more common in TB and all mycobacterial infections compared to other causes of GLD in our study.
The nodular pattern and focal distribution were the commonest CT features in overall patients,
which can be explained by the crescent indication of lung biopsies for investigation of indeterminate solitary pulmonary nodules suspected for malignancy [11].
Histoplasma infections presentes the same predominant imaging features on CT and should be considered a differential diagnosis in the investigation of solitary pulmonary nodules in asymptomatic patients,
specially when neoplasms are of low probability or discarded and pathology suggests granulomatous disease [12].