PULMONARY BLASTOMYCOSIS IN CHILDREN - FINDINGS ON CHEST RADIOGRAPHS

OBJECTIVE. The purpose of this study was to identify characteristic ra diographic findings in children with pulmonary blastomycosis. SUBJECTS AND METHODS. We reviewed the charts and radiographs of 18 children wi th culture-proven acute pulmonary blastomycosis. The 10 boys and eight girls were from 1 to 16 years old. Sixteen were Native Canadian India ns, and two were white. All available chest radiographs, including tho se obtained in follow-up after treatment was terminated, were reviewed by a pediatric radiologist. Consolidation was classified by location and extent, and other abnormalities were noted. RESULTS. Initial chest radiographs showed consolidation in 16 patients, Seven patients had s ingle lobe involvement, most commonly of the left lower lobe. Nine pat ients had multiple lobe involvement. The left lower lobe was most comm only involved in these cases, but the middle lobe was most severely af fected. The upper robes were involved only in children with multiple r obe disease and were only mildly affected. Cavitation developed in two patients, followed by bronchogenic spread of the disease. Pleural eff usions were seen in three patients; two also had rib lesions, Hilar ad enopathy developed in two children. Five patients had radiographs avai lable, which had been obtained more than a year after onset, and three of these were abnormal. CONCLUSION. The most common radiologic findin g in children with pulmonary blastomycosis is pulmonary consolidation in one or several lobes, which may undergo cavitation. Lymphadenopathy and pleural effusions are uncommon. Chronic abnormalities may develop .