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Weekly Chest CasesArchive of Old Cases

Case No : 714 Date 2011-07-06

  • Courtesy of Dong-Wook Sung, M.D., Bo-Ram Park, M.D. / KyungHee University Hospital
  • Age/Sex 49 / M
  • Chief ComplaintIncidental cavitary mass on chest radiography. History of diabetes and renal transplantation.
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Mucormycosis
Radiologic Findings
Chest PA shows a RUL mass with cavity.
Chest CT demonstrates mass with cavity and focal air-fluid level in right upper lobe. Some bubbly lucencies are seen in peripheral portion.
Brief Review
Wedge resection for the mass in right upper lobe was done and the pathology revealed non-segmented hyphae with right angle branching pattern, typical findings of mucormycosis.
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,

No. of Applicants : 119

▶ Correct Answer : 17/119,  14.3%
  • - UWO , Canada S Lee
  • - National Jewish Health , United States Jonathan Chung
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Istanbul , Turkey Armagan Sarac
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Saga University , Japan Tetsuya Kondo
  • - CHA Bundang hospital , Korea (South) Hyerin Kim
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Gifu Chuo Hospital , Japan Yo Kaneko
  • - NASA SCANS , India RAKESH BHATIA
  • - Severance hospital , Korea (South) Saerom Hong
  • - Vikram hospital , India Pravin Mahadevappa
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Chonnam national univ. hospital , Korea (South) Choi Seul Gi
▶ Correct Answer as Differential Diagnosis : 21/119,  17.6%
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - sunder lal jain hospital , India SANJEEV KUMAR VACHHER
  • - Okayama university, Department of Pathology , Japan Junya Itakura
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - University of British Columbia , Canada Amr Ajlan
  • - Saga University , Japan Ryoko Egashira
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - Seoul St Mary Hospital , Korea (South) Chae Lim
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - All India Institute of medical sciences , India Justin Moses
  • - Armed Forces Yangju Hospital , Korea (South) Ho-Joon Lee
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