대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Mucormycosis (Zygomycosis)

Radiologic Findings

Chest radiograph shows large areas of consolidation in left middle and lower lung zones. Chest CT demonstrates multifocal peribronchial consolidation and nodules in LUL and lobar consolidation with partial aeration in LLL. Multiple enlarged lymph nodes with central necrosis are also noted in mediastinum and left hilum. CT scan at the pulmonary trunk level reveals partial obstruction of left lower lobar bronchus by low density materials and focal filling defect in left superior pulmonary vein. The photomicrograph of bronchoscopic biopsy specimens reveals non-segmented hyphae with right angle branching pattern, typical findings of mucormycosis.

Brief Review

Pulmonary mucormycosis is caused by fungi belonging to the Mucorales order. Mucormycosis occurs almost invariably in patients who are not fully immunocompetent. Patients with diabetes or a hematologic malignancy are particularly susceptible. Mucormycosis may present as in infection of the upper respiratory tract (particularly the sinuses) or the lungs.

The most common radiographic abnormality is progressive, homogenous, lobar or multilobar consolidation. Pathologically, consolidation presents confluent pneumonia or pulmonary infarction and hemorrhage from large vessel thrombosis. Occasionally there may be pleural effusions or hilar lymphadenopathy. Bronchial occlusion and pulmonary pseudoaneurysms are infrequent and are more likely to be appreciated on CT. Because of the angioinvasive nature of mucormycosis, the masslike lesions may show the ground-glass halo sign on CT, representing surrounding hemorrhage. Once infarction has occurred, cavitation of the necrotic lung ensues, with an air crescent within the consolidation.

References

1. McAdams HP, Christenson MR, Strollo DC, Edward FP. Pulmonary mucormycosis: radiologic findings in 32 cases. AJR 1997;168:1541-1548.

2. Libshitz HI, Pagani JJ. Aspergillosis and Mucormycosis: Two types of opportunistic fungal pneumonia. Radiology 1981;140:301-306.

Keywords

Lung, Infection, Fungal infection,