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Weekly Chest CasesArchive of Old Cases

Case No : 1110 Date 2019-02-06

  • Courtesy of Su Yeon Ahn, MD., Jeong Geun Yi ,MD / Konkuk University Medical Center
  • Age/Sex 73 / M
  • Chief Complaintgeneral weakness (3DA), DM patient
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

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,

No. of Applicants : 82

▶ Correct Answer : 47/82,  57.3%
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - MD , India DEEPANDER SINGH RATHORE
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - The Jikei university , Japan TAKU GOMI
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Myongji Hospital , Korea (South) KI EON KWON
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Wuhan Union Hospital , China NANCHUAN JIANG
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
  • - National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Dae Jin Medical Center , Korea (South) JIYOUNG CHOI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Gyeongsang National University Hospital , Korea (South) KWON HWANWOONG
  • - Seoul National University Hospital , Korea (South) SE WOO KIM
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - , Korea (South) KIM JI HOON
  • - Columbia asia refferal hospital,Bengaluru , India PRAVIN KUMAR M
  • - , Korea (South) SEUNGYOON CHAE
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Yonsei University,Severance Hospital , Korea (South) SUJI LEE
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Korea (South) JONGSUN LEE
  • - Private sector , Greece VASILIOS TZILAS
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
  • - Japanese Red Cross Wakayama Medical Center , Japan AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 13/82,  15.9%
  • - Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - The University of Tokyo Hospital , Japan MASAFUMI KAIUME
  • - McGill University Health Center , Canada Alexandre Semionov
  • - , Korea (South) CHOHEE KIM
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - , Korea (South) JANG SEONG WON
  • - TB centre kasaragod. , India rikhy krishnan
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
▶ Semi-Correct Answer : 4/82,  4.9%
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - , Japan HISATAKA ITO
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Korea University Guro Hospital , Korea (South) KYU-CHONG LEE
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