SKELETAL COCCIDIOIDOMYCOSIS - IMAGING FINDINGS IN 19 PATIENTS

Objective. The objective of this study was to describe the distributio n and radiologic appearance of skeletal coccidioidomycosis in 19 docum ented cases. Design and patients. Medical records of 19 patients (17 m en, 2 women; age range 17-62 years, mean age 34 years) with clinically confirmed skeletal coccidioidomycosis were retrospectively reviewed. The patients were studied with plain radiography (n=19), skeletal scin tigraphy (n=6), computed tomography (CT) (n=5), and magnetic resonance imaging (MRI) (n=1). Results. Multiple lesions were seen in 11 of 19 patients (58%). Of a total of 46 lesions, 27 (59%) were described as p unched-out lytic, 10 (22%) as permeative/destructive, and 9 (17%) as i nvolving a joint and/or disk space. Lesions were identified in almost every bone (with the exception of the facial bones, ulna, carpus, and fibula) and were most commonly found in the axial skeleton (20 of 46; 43%). Conclusion. Skeletal coccidioidomycosis is frequently multicentr ic and may involve almost any bone. The axial skeleton is the most com mon site of involvement. Lesions are usually well demarcated but may p resent with an ill-defined border and permeative type of bone destruct ion, especially in the spine. Joint involvement is not uncommon. Plain radiographs are effective in the initial evaluation of bones and join ts, scintigraphic studies can identify disseminated disease, and CT an d MRI are effective in determining soft tissue involvement and spinal abnormalities.