Nocardia infection in patients with liver transplants or chronic liver disease: radiologic findings.

The radiologic findings in eight patients with nocardiosis were reviewed. Infection followed liver transplantation in six cases and was associated with chronic liver disease in two. Abnormalities of the chest radiograph predominated and included pleural effusions (n = 6), consolidation (n = 5), cavitating lesions (n = 1), and intrapulmonary nodules (n = 3), but there were no diagnostic features. The diagnosis was made on the basis of bronchial washings (n = 3), skin aspiration (n = 3), pleural fluid (n = 1), and aspiration biopsy of a pulmonary nodule (n = 1). Computed tomography (CT) was helpful in evaluating chest disease in three cases and allowed guided biopsy to obtain material for a definitive diagnosis. In three patients skin lesions in disseminated disease were associated with cerebral lesions seen at CT. A definitive tissue diagnosis is especially important in patients who have received transplants because of malignancy, since the radiologic manifestations of this unusual infection may mimic metastatic recurrence. Conventional radiography and CT are nonspecific but will enable determination of disease extent and selection of the most suitable site for tissue sampling, which is required to confirm the diagnosis.