Cavities, Coccidioidomycosis, and Food

Cavity formation is a common manifestation of acute and chronic pulmonary coccidioidomycosis. It is thought to result from necrosis of a coccidioidal granuloma or in areas of previous consolidation.

The cavities in coccidioidomycosis may be thin-walled "grape skin" cysts (more common) or thick-walled "dough nut" cavities. The thick-walled cavities may revert to thin-walled cysts with rapid inflation and deflation, a sequence very suggestive of coccidioidal infection.

While most cavities associated with coccidioidomycosis are silent and of little clinical significance, they may harbor aspergillosis or coccidioidal mycetoma, which may dissect from the cavity and cause empyema, pneumothorax, or bronchopleural or bronchocutaneous fistulas. They may also be secondarily infected by bacteria, leading to pyogenic lung abscesses.

A much rarer form of cavity in coccidioidomycosis is chronic cavitary coccidioidal pneumonia, which resembles apical fibrotic tuberculosis.

References

• Capone D, Marchiori E, Wanke B, Dantas KE, Cavalcanti MA, Deus Filho A, Escuissato DL, Warszawiak D. Acute pulmonary coccidioidomycosis: CT findings from 15 patients. Br J Radiol. 2008 Sep;81(969):721-4.
• McGahan JP, Graves DS, Palmer PE, Stadalnik RC, Dublin AB. Classic and contemporary imaging of coccidioidomycosis. AJR Am J Roentgenol. 1981 Feb;136(2):393-404.