Unveiling basidiobolomycosis: key imaging features and clinical correlations

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. 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. 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. 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.