Unveiling basidiobolomycosis: key imaging features and clinical correlations.
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BACKGROUND: Basidiobolomycosis is a fungal infection exhibiting a wide spectrum of clinical manifestations that frequently resemble abdominal malignancies or inflammatory conditions. This study elucidates the characteristic imaging features that can help make an accurate diagnosis. METHODS: We examined pretreatment imaging studies (CT, MRI, ultrasound) of 32 histopathologically proven cases of basidiobolomycosis at a tertiary referral center between 2015 and 2021. Two radiologists, blind to the pathology results, scrutinized the lesions for localization, morphology, enhancement pattern, and ancillary findings. RESULTS: The cohort (mean age 9.8 ± 13.8 years and 53% male) demonstrated three basic imaging patterns: (1) hepatic lesions (21.9%) appearing as heterogeneously enhancing masses with necrotic cores; (2) gastrointestinal involvement (18.8%) showing circumferential wall thickening chiefly affecting the ileocecal region; and (3) mesenteric masses (15.6%) with peripheral enhancement and central necrosis. Other findings included regional lymphadenopathy (31.3%) and obstructive uropathy. At first, the misdiagnosis rate was 78%, most frequently as malignancy (37.5%) or appendicitis (31.2%). The follow-up indicated that 90.6% were responsive to treatment. CONCLUSION: Basidiobolomycosis shows distinct imaging characteristics, especially necrotic hepatic masses, and segmental bowel wall thickening, which could help differentiate the condition from neoplasms or inflammatory diseases. These findings act as a compelling argument to always include fungal etiologies within the differential diagnosis in patients with pertinent imaging findings in endemic regions.