The Computed Tomography Findings and Follow-up Course of Pulmonary Nocardiosis

Abstract

Objective Our study aimed to elucidate the computed tomography (CT) features and follow-up course of pulmonary nocardiosis patients to improve the understanding and diagnostic accuracy of this disease. Methods The chest CT findings and clinical data of patients diagnosed with pulmonary nocardiosis by culture or histopathological examination in our hospital between 2010 and 2019 were retrospectively analyzed. Results A total of 34 cases of pulmonary nocardiosis were included in our study. Thirteen patients were on long-term immunosuppressant therapy, among whom 6 had disseminated nocardiosis. Among the immunocompetent patients, 16 had chronic lung diseases or a history of trauma. Multiple or solitary nodules represented the most common CT feature (n = 32, 94.12%), followed by ground-glass opacities (n = 26, 76.47%), patchy consolidations (n = 25, 73.53%), cavitations (n = 18, 52.94%), and masses (n = 11, 32.35%). There were 20 cases (61.76%) with mediastinal and hilar lymphadenopathy, 18 (52.94%) with pleural thickening, 15 (44.12%) with bronchiectasis, and 13 (38.24%) with pleural effusion. Significantly higher rates of cavitations were observed among immunosuppressed patients (85% vs 29%, P = 0.005). At follow-up, 28 patients (82.35%) clinically improved with treatment, while 5 (14.71%) had disease progression, and 1 (2.94%) died. Conclusions Chronic structural lung diseases and long-term immunosuppressant use were found as risk factors for pulmonary nocardiosis. While the CT manifestations were highly heterogeneous, clinical suspicion should be raised upon findings of coexisting nodules, patchy consolidations, and cavitations, particularly in the presence of extrapulmonary infections such as those of the brain and subcutaneous tissues. A significant incidence of cavitations may be observed among immunosuppressed patients.