Radiologists must be ‘cognizant’ of image origin, patient location to diagnose fungi diseases

Radiologists must be aware of patients’ geographic location and where images originate to correctly diagnose regional fungi diseases, experts warned recently.

Clinical radiologists from California to Kansas City specifically directed their call toward teleradiologists, who likely interpret digital images from regions across the U.S.

In many locations, such as the Mississippi and Ohio river valleys and Pacific Northwest, patients are routinely exposed to native fungi, causing baseline infection rates. But for providers unfamiliar with these regions, and many others, such diagnoses may not be top of mind, researchers explained in RadioGraphics. In these situations, providers need to be resourceful.

“The patient demographics, clinical history, and location are clues that may lead to a proper diagnosis of endemic fungal disease,” Jeffrey R. Kunin, MD, a clinical radiologist at the University of Missouri-Columbia, and colleagues added Feb. 5 “The radiologist should be cognizant of the patient location to provide a correct and timely radiologic diagnosis that helps guide the clinician to initiate appropriate therapy.”

With this in mind, the team reviewed endemic fungi (an infection that affects particular people in a geographic region within the U.S.), analyzing locations, varying disease pathologies, differentiating features of each fungus, and real-world cases.

Traditionally, people are exposed to spores that enter through the respiratory system. Infected patients are often asymptomatic, but may come in with flu-like symptoms such as fever, cough, or dyspnea. In other cases, however, side effects are vague and might include weight loss, fever, chills, and malaise.

In terms of imaging findings, radiologists should be on the lookout for thoracic radiography and CT consolidation, nodules, cavities, lymphadenopathy, and pleural disease. And on PET scans, 18–fluorodeoxyglucose uptake with active acute or chronic infections may indicate exposure.

One final warning: It may be easy to confuse nonspecific imaging findings with other disease processes, including malignancy, the authors cautioned.

“The ability to acquire and interpret radiologic images in different locations can result in new diagnostic dilemmas and challenges for the radiologist,” the authors concluded, adding that “radiologist[s] must be aware of the patient location in the interpretation of thoracic imaging studies.”

Read much more from Kunin and colleagues here.