대한흉부영상의학회 Weekly Chest Cases

Case No : 270 Date 2002-12-28

Courtesy of Kyung-Hyun Do, M.D., Joon Beom Seo, M.D. / Asan Medical Center, Seoul, Korea
Age/Sex 63 / F
Chief ComplaintKnown DM, malignant brain tumor, headache, no respiratory symptom

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Diagnosis With Brief Discussion

Diagnosis: Mucormycosis
Radiologic Findings: Chest radiograph shows mass with centrial cavity in right middle lung zone and small nodular lesion in left mid lateral lung zone. Chest CT scans show nodule or mass with central cavity and areas of low density in both lungs.

Transthoracic needle aspiration for the mass in right lower lobe was done and the pathology revealed non-segmented hyphae with right angle branching pattern, typical findings of mucormycosis.
Brief Review: Pulmonary mucormycosis is relatively uncommon but an important opportunistic fungal infection in immunocompromised persons. The literature on the subject is sparse. Lee, et al searched the MEDLINE database for articles published in the English-language literature since 1970 and carefully analyzed 87 cases (1). The main risk factors were diabetes mellitus, hematologic cancers, renal insufficiency, and organ transplantation. Several patients had no apparent immune compromise. There was a predilection for involvement of the upper lobes. Air crescent signs on chest x-ray films were predictors of pulmonary hemorrhage and death from hemoptysis. The overall survival rate was 44%. Patients treated with a combined medical-surgical approach had a better outcome than patients who did not undergo surgery. Thus, this relatively rare but often fatal disease should be suspected in immunocompromised patients who fail to respond to antibacterial therapy. Early recognition and aggressive management are warranted to maximize chances for cure. Optimal therapy requires systemic antifungal therapy, surgical resection, and, when possible, control of the patient's underlying disease.
Tables from reference 1
References: 1. Lee FY, Mossad SB, Adal KA. Pulmonary mucormysosis: the last 30 years. Arch Intern Med 1999;159:1301-1309
Keywords: Lung, Infection,

No. of Applicants : 22

▶ Correct Answer : 3/22, 13.6%

- Ewha Womans University Hospital, Korea Ji Young Hwang
- Ospedale di Jesi, Italy Giancarlo Passarini
- Taipei Municipal Jen-Ai Hospital, Taiwan Hui-Ju Tsai

▶ Semi-Correct Answer : 15/22, 68.2%

- Annecy Hospital, France Gilles Genin
- Asan Medical Center, Korea Eun Jin Chae
- Chonnam National University Hospital Woong Yoon
- Choong-ju Hospital Konkuk University, Korea Chang Hee Lee
- CHRU Lille, France Philippe Dumont
- CHU Nancy-Brabois, France Denis Regent
- Gwangmoung Seongae Hospital, Korea Jiyong Rhee
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Hospital of Leon, Spain Inmaculada Herraez
- Jecheon Public Health Center, Korea Seung Hun Ryu
- Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
- Pohang St. Mary's Hospital, Korea Taegwon Kim
- Sarang Hospital, Incheon, Korea Jung Hee Kim
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 270 Date 2002-12-28

Discussion

No. of Applicants : 22