Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Pulmonary mucormycosis
- Radiologic Findings
- Plain radiograph showed multiple cavitary lesions on the both lung fields. Lung window setting CT image showed multiple GGO lesions with surrounding consolidation (reverse halo sign). Increase in size and cavitary change of previous lesions with bilateral pleural effusion were noted on follow up image. Last image revealed improvement of multiple lung lesions after long-term administration of antifungal agent. On sputum culture, Rhizopus microspores (fungus) was detected.
- Brief Review
- Mucormycosis is an opportunistic infection caused by fungi of the class Zygomycetes, caused by fungal species in the genera Rhizopus, Lichtheimia, and Mucor. Risk factors for infection include diabetes (especially in the setting of diabetic ketoacidosis), hematologic malignancy, stem cell or solid organ transplantation, immunosuppression, graft-versus-host disease, and desferoxamine therapy.
Imaging findings are mostly nonspecific and include consolidation, nodules, masses, cavities, lymphadenopathy, and pleural effusion. Findings suggestive of invasive fungal infection include the air crescent sign (a thin rim of air between the necrotic lung and the surrounding parenchyma) and the halo sign (consolidation with a rim of surrounding GGO). Relatively large size of halo indicates that mucormycosis results in greater pulmonary hemorrhage than other angioinvasive infections, such as Aspergillus infections, that typically have only a small halo around the nodules. The lesions had a peripheral predominance and some patients showed vascular cutoff sign.
Treatment for mucormycosis depends on antifungal agents, surgery, and control of predisposing conditions. Amphotericin B and, more recently, posaconazole are efficacious in the treatment of mucormycosis. Voriconazole is not effective, although it is effective in the treatment of aspergillosis.
- References
- 1. Hammer MM, Madan R, Hatabu H. Pulmonary Mucormycosis: Radiologic Features at Presentation and Over Time. AJR Am J Roentgenol. 2018;210:742-747
2. Chung JH, Godwin JD, Chien JW, Pipavath SJ. Pulmonary mucormycosis. Radiology. 2010;256:667-70
- Keywords
- Lung, Fungal infection,