Clinical presentation, radiographic findings, and diagnostic methods of pulmonary blastomycosis: A review of 100 consecutive cases

Background. We sought to determine the relationship among radiographic find ings, clinical presentation, and diagnostic testing of pulmonary blastomyco sis. Methods. We reviewed the medical records of 100 consecutive patients with p ulmonary blastomycosis. Results, Air-space infiltrates were the usual radiographic finding of pulmo nary blastomycosis. Mass-like infiltrates were associated more with chronic than acute presentations. Air-space and mass-like infiltrate were predomin ately involved in the upper lobes. Sputum analysis made the initial diagnos is of blastomycosis most often.-Acute and chronic presentations were not di fferent between immunosuppressed patients and the remainder of the patients . In addition, infiltrates on chest radiographs in immunosuppressed patient s were similar to the other patients. Conclusions. In an endemic area, pulmonary blastomycosis should be consider ed for any pulmonary infiltrate, especially in the upper lobes. Sputum anal ysis in most cases aids in the diagnosis, but bronchoscopy and/or tissue bi opsy should be considered if the suspicion of blastomycosis is high and spu tum analysis is inconclusive, negative, or not possible. Follow-up with che st radiographs after antifungal therapy is reasonable until complete resolu tion or fibrotic changes in patients with pulmonary blastomycosis.