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Weekly Chest CasesArchive of Old Cases

Case No : 1135 Date 2019-07-30

  • Courtesy of Hyeon Jun Jang, Kyung Min Shin / Kyungpook National University Chilgok Hospital
  • Age/Sex 14 / F
  • Chief ComplaintFever, blood tinged sputum, ALL patient on chemotherapy
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Tracheobronchial mucormycosis
Radiologic Findings
Fig 1~2. Contrast-enhanced CT images show low density nodule in the upper trachea with mediastinal fat invasion.
Fig 3~5. Contrast-enhanced CT images show nodular, enhancing wall thickening of the trachea and right main bronchus.
Bronchoscopic exam showed diffuse narrowing with white-brownish pseudomembrane. The growth of Mucormycosis was observed in the bronchial washing specimen. The patient died of massive hemoptysis.

Expectorated material during massive hemoptysis

Brief Review
Tracheobronchial mucormycosis is usually delayed and ultimately made by autopsy because of its nonspecific clinical presentations. Serious complications develop because the pathogen invades the airways and hilar vessels which may result in atelectasis, abscess formation and hemorrhage.
Endobronchial involvement is a rare presentation of mucormycosis. Endobronchial mucormycosis has been described in the literature and the lesions have been identified as gray-white mucoid materials that frequently block a major airway. The involved airways are typically edematous and necrotic. In the previous study, CT scans showed luminal narrowing and wall thickening of the mid- or distal trachea and bronchi, variably sized mediastinal lymph nodes, nonspecific pulmonary opacities, and a large lung abscess. There were intramural air collections within the thickened bronchial wall, nonenhancing low attenuation thickening of the bronchial wall, and bronchonodal fistula.
In the previous report including 12 cases, ninety-five percent patients had immunosuppressive diseases such Diabetes mellitus with or without ketoacidosis, corticosteroid therapy, and renal insufficiency. Majority of pathological diagnosis was made by the transbronchial biopsy (76.7%). However, bronchoscopic biopsy itself can be catastrophic because of fatal hemorrhage. Tracheobronchial mucormycosis is a rare but severe disease with high mortality because of its nonspecific clinical presentations and variable predisposing factors.
Please refer to
Case 735,
KSTR Imaging Conference 2006 Spring  Case 6,
References
1. Report of 12 cases with tracheobronchial mucormycosis and a review. He R, Hu C, Tang Y, Yang H, Cao L, Niu R. Clin Respir J. 2018;12:1651–1660
2. Mucormycosis of the central airways: CT findings in three patients. Kim KH, Choi YW, Jeon SC, Shin DH, Jung JI, Seo HS, Hahm CK. J Thorac Imaging. 1999 Jul;14(3):210-4
Keywords
Airway, Fungal infection, Mucormycosis,

No. of Applicants : 62

▶ Correct Answer : 1/62,  1.6%
  • - , Korea (South) JAEHEUNG BAE
▶ Correct Answer as Differential Diagnosis : 22/62,  35.5%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Ajou University School of Medicine , Korea (South) JUNG YONG JUN
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - Private sector , Greece VASILIOS TZILAS
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
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