Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Pulmonary mucormycosis
- Radiologic Findings
- Chest radiograph shows mass-like opacities in the left upper lung field and the right hilar area. Chest CT shows multiple GGO lesions with surrounding consolidation (reverse halo sign) in both lungs. On follow-up chest radiograph taken 5 days later revealed increase in size of preexisting lesions and a newly appeared consolidation with bilateral pleural effusions. On bronchoscopic biopsy, mucormycosis was confirmed.
- Brief Review
- Pulmonary mucormycosis is a relatively rare and often fatal opportunistic infection caused by fungi of the class Zygomycetes, order Mucorales. The main risk factors are diabetes, hematologic malignancy, renal insufficiency, organ transplantation, and metabolic acidosis. It most commonly involves the sinuses, lungs, and skin.
Angioinvasion of fungi may cause thrombosis of pulmonary vessels and parenchymal necrosis. Radiologic findings of consolidation, solitary or multiple nodules with or without cavitation, halo or reversed-halo sign, pleural effusion and lymphadenopathy are shown, mostly nonspecific.
It is important to distinguish mucormycosis from aspergillosis, because the treatments can differ and appropriate early treatment of mucormycosis may improve the outcome. The reverse halo sign was more common and airway-invasive features were less common in patients with pulmonary mucormycosis than in those with invasive pulmonary aspergillosis. 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.
The overall mortality rate of pulmonary mucormycosis is 45%, and patients treated with combined medical-surgical approach have better outcomes than those treated conservatively.
- Please refer to
Case 223, Case 270, Case 411, Case 559, Case 714, Case 720, Case 990, Case 1103, -
KSTR imaging conference 2018 Spring Case 9
,
KSTR imaging conference 2017 Spring Case 11,
- References
- 1. J H Chung, J D Godwen, J W Chien, et al. Pulmonary mucormycosis, Radiology 2010;256:667-670
2. J Jung, M Y Kim, H J Lee, et al. Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis. Clin Microbiol Infect 2015;21:684.el1-684.dl8
3. S Chong, K S Lee, C A Yi, et al. Pulmonary fungal infection: Imaging findings in immunocompetent and immunocompromised patients , EJR 2006;59:371-383
4. Hammer MM, Madan R, Hatabu H. Pulmonary Mucormycosis: Radiologic Features at Presentation and Over Time. AJR Am J Roentgenol. 2018;210:742-747
- Keywords
- Lung, Fungal infection,