Coccidioidal Pulmonary Cavitation

1. Two hundred eleven cases of coccidioidal pulmonary cavitation have been reviewed. 2. Cavitation is found in about 2 per cent of hospitalized patients with coccidioidomycosis. 3. Fifty-four per cent of these patients were asymptomatic and cavitation was detected on routine chest roentgenograms. 4. Eighty-six per cent of the patients had a single cavity and 14 per cent had multiple cavities. Of those with unilateral disease, 54 per cent were on the right side and 46 per cent on the left side. Ten patients, or 5 per cent of the total, had bilateral involvement. 5. Fifty-four per cent of the patients had positive coccidioidin skin tests and 82 per cent had positive coccidioidal serologic studies. Sixty-four per cent had positive sputum cultures for C. immttis. 6. Non-surgical and surgical management of coccidioidal pulmonary cavities have been compared. In the former group, half of the cavities closed spontaneously although 25 per cent of the patients had occasional hemoptysis which was usually slight. 7. Of the 108 patients treated with resectional surgery, two died postoperatively, 30 per cent developed postoperative bronchopleural fistulae, and 18 per cent developed new coccidioidal cavities postoperatively. 8. On the basis of the present study, a conservative, non-surgical regimen appears to be most desirable for the treatment of coccidioidal cavitation unless (a) the cavity is peripheral and has enlarged significantly, or (b) there have been recurrent severe hemoptyses.