Pulmoner kriptokokkoz

Özet

Cryptococcus inhalasyonla akciğere ulaşır; enfeksiyon hem bağışıklığı normal kişilerde sınırlı nodül olarak hem de bağışıklığı baskılanmış kişilerde yaygın akciğer veya sistemik hastalık olarak görülebilir. Toraks BT tek ya da kümelenmiş nodülleri, kitle benzeri konsolidasyonu ve eşlik edebilecek buzlu cam, kavite, lenf nodu veya plevra bulgularını tanımlar. Görüntüleme kanserden güvenilir biçimde ayırmayabilir; BT dağılımı ve yayılımı gösterir, kesin tanı mikrobiyoloji veya doku değerlendirmesine dayanır. Nodülün malignite sanılması gereksiz gecikmeye, enfeksiyonun veya eşlik eden santral sinir sistemi yayılımının gözden kaçması ise ciddi sonuçlara yol açabilir.

Faz ve pencere

HRCT tanısal

Kontrastsız ince kesit toraks BT'de tek, kümelenmiş veya dağınık yuvarlak nodül/kitleler, subplevral yerleşim, kitle benzeri ya da hava bronkogramlı konsolidasyon; eşlik eden buzlu cam, kavite ve küçük hava yolu opasiteleri incelenir.

BT bulguları

• Tek veya çok sayıda, iyi ya da kısmen sınırlı parankimal nodül; bazıları kümelenmiş, bazıları ayrı dağılmıştır
• Subplevral yerleşimli tek veya çok sayıda nodül veya kitle.
• Kitle benzeri fokal konsolidasyon; içinde hava bronkogramı ve çevresinde buzlu cam bulunabilir
• İmmün baskılanmış hastada nodül ya da kitle içinde kaviteleşme
• Nodül çevresinde halo biçimli buzlu cam; etkeni tek başına tanımlamaz
• Pnömoni tipi pulmoner kriptokokkozda iki taraflı dağılım görülebilir.
• Mediastinal/hiler lenf nodu büyümesi ve plevral sıvı eşlik edebilir, ancak her hastada beklenmez
• Pulmoner kriptokokkozda baskın bir nodüle başka loblarda ek nodüller eşlik edebilir; bu dağılım metastazı düşündürebilir.

Normalde

Normal akciğer kesitinde sekonder pulmoner lobüller homojen havalı görünür; subplevral alanlarda yuvarlak yumuşak doku nodülü veya fokal hava boşluğu konsolidasyonu bulunmaz. Aynı seviyede karşı lobun plevral yüzeyini, segmental bronşların açıklığını ve mediastinal penceredeki hiler düğümlerin boyut/şekil benzerliğini lezyonlu tarafla karşılaştır.

Ayırıcı tanı

Primer akciğer kanseri

spikülasyon, bronş tıkanması ve aynı lobda sekonder değişiklikler görülebilir; kriptokokkozdan BT ile kesin ayrılamayan tek kitle olabilir.

Metastaz

rastgele dağılan çoklu yuvarlak nodüller ve bilinen primer tümör öyküsü ayırıcıda öne çıkar.

Tüberküloz

üst lob kavitesi, sentrilobüler ağaç tomurcuk opasiteleri veya nekrotik lenf nodları destekleyebilir.

İnvaziv aspergilloz

nötropeni zemininde halo, nodül ve kavite yapabilir; konak durumu ve seri değişim önem taşır.

Bakteriyel bronkopnömoni

segmental/lobüler konsolidasyon ve bronş çevresi sentrilobüler opasiteler belirgin olabilir.

Organize pnömoni ve septik emboli gibi inflamatuvar veya enfeksiyöz süreçler, çoklu pulmoner nodüllerin ayırıcı tanısında düşünülebilir; bu nodüllerin görüntüleme özellikleri tek başına özgül değildir.

Tuzaklar

• Kriptokok nodülleri yüksek FDG tutulumu göstererek maligniteyi taklit edebilir; PET veya tek BT bulgusuyla kesin malignite tanısı konulamaz.
• Kavite ve halo immün baskılanmış hastada daha görünür olabilir; bu işaretlerin yokluğu kriptokokkoz tanısını dışlamaz.
• Soliter odak bulunan hastada eşlik eden küçük nodüller ince kesitlerde gözden kaçabilir; her iki akciğeri aynı pencerede tarayarak dağılımı belirle.
• Hiler/mediastinal lenf nodu ve plevral sıvı değişkendir; yoklukları akciğer kriptokokkozuna karşı kanıt değildir.
• Pulmoner kriptokokkoz santral sinir sistemine yayılabilir; bu yayılımı dışlamak için ayrıca değerlendirme gerekir.

Kendini dene

1. Bağışıklığı normal hastada alt lobda kümelenmiş subplevral nodüller ve fokal hava bronkogramlı konsolidasyon görülüyor. Bu BT bulguları için en doğru yorum hangisidir?

   • Kriptokokkoz ayırıcı tanıda yer alır; BT etkeni kesinleştirmez ve klinik-mikrobiyolojik korelasyon gerekir.
   • Bulgular pulmoner emboliyi kesin olarak gösterir.
   • Görünüm kardiyojenik ödem için tanısaldır.
   • Subplevral nodüller enfeksiyonu dışlar.
   Cevabı göster

   Kriptokokkoz ayırıcı tanıda yer alır; BT etkeni kesinleştirmez ve klinik-mikrobiyolojik korelasyon gerekir.. Pulmoner kriptokokkoz nodül veya kitle şeklinde görülebilir ve görüntüleme bulguları özgül değildir; tanı serum kriptokok antijeni ve histopatolojik inceleme gibi yöntemlerle desteklenebilir.

2. Tek kriptokok benzeri nodül FDG tutuyor ve kenarları düzensiz. Bu PET/BT bulgusu için en doğru yorum hangisidir?

   • Enfeksiyon ile kanseri ayıramaz
   • Kriptokokkozu kesinleştirir
   • Metastazı dışlar
   • Bakteriyel apseyi kanıtlar
   Cevabı göster

   Enfeksiyon ile kanseri ayıramaz. Kriptokok nodülleri FDG tutulumu ve düzensiz sınırla maligniteyi taklit edebilir; PET görünümü etkeni kesinleştirmez. Doku veya mikrobiyolojik doğrulama gerekir; diğer seçenekler görüntüleme bulgusuna aşırı tanısal kesinlik yükler.

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.