Purpose or Case Report: Blastomycosis is a rare granulomatous fungal infection, endemic to Canada and Midwest of the North America. The clinical features of blastomycosis are extremely variable, since the disease may involve any organ or system. Pediatric blastomycosis is uncommon, and the diagnosis is often delayed, which results in severe and disseminated disease by the time of diagnosis. Imaging studies plays an important role in the diagnosis and management of pediatric patients with blastomycosis.
The purpose of our educational exhibit is to describe the imaging features of pulmonary and extrapulmonary blastomycosis in the pediatric population.
Methods & Materials: We present a pictorial review discussing the imaging findings and characteristics of the varying presentations of pulmonary and extrapulmonary blastomycosis in children aged 2 months to 17 years, emphasizing the most unusual and challenging for diagnosis.
Our presentation includes different patterns of pulmonary blastomycosis, which can mimic bacterial pneumonia, a mass lesion, interstitial disease or pulmonary TB. We present challenging cases of skeletal involvement with scoliosis and bony destruction, which can mimic a malignant process or bacterial osteomyelitis/discitis. Our cases of CNS involvement of blastomycosis include: mass-like brain lesion, brain abscess, spinal inflammatory mass and a very unusual case of a pituitary mass lesion with involvement of the hypothalamo-hypophyseal axis, leptomeningial spread and ventriculitis.
Results: The most challenging for imaging assessment are cases of extrapulmonary presentation of blastomycosis in young children, especially in the absence of a history of a prior infectious exposure.
Conclusions: In order to provide the correct and prompt diagnosis of this rare type of infection the pediatric radiologist should be familiar with the different and multiple imaging manifestations of blastomycosis.