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Weekly Chest CasesArchive of Old Cases

Case No : 223 Date 2002-02-02

  • Courtesy of Kyungnyeo Jeon, M.D., Duk-Sik Kang, M.D. / Kyungpook National University Hospital, Taegu, Korea
  • Age/Sex 44 / M
  • Chief ComplaintCoughing with sputum for 4 days. Underlying DM and end stage renal disease
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Pulmonary Mucormycosis
Radiologic Findings
Chest PA shows a poorly marginated perihilar mass in the left lung. Chest CT demonstrates focal consolidation in left upper lobe. Central low attenuation with bubbly lucencies and perilesional ground-glass opacity are noted. Follow-up chest radiograph obtained after 11 days shows multiple cavities within the lesion.

The photomicrograph of CT-guided biopsy specimen depicts fungus that has characteristics of nonseptate broad hyphae with right angle branching.
Brief Review
Pulmonary mucormycosis is relatively rare, often fatal, opportunistic infection caused by fungi of the class Zygomycetes, order Mucorales. The main risk factors are diabetes mellitus, hematologic malignancy, renal insufficiency, and organ transplantation. The most common radiologic manifestation of pulmonary mucormycosis is progressive, homogeneous, lobar or multilobar consolidation without lobar predilection. Pathologically, consolidation represents confluent pneumonia or pulmonary infarction and hemorrhage from large vessel thrombosis. Less commonly, one or multiple nodules or masses may predominate. Cavitation or abscess formation can be seen. Occasionally there may be pleural effusion or hilar lymphadenopathy. CT findings include focal or diffuse areas of low attenuation within consolidation and the halo sign, representing hemorrhage caused by vascular invasion. Although the presence of organisms in a culture from the respiratory tract is suggestive, definite diagnosis requires histologic demonstration of the organism in affected tissue. Overall mortality rate of pulmonary mucormycosis is 45%.
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, immune related,

No. of Applicants : 16

▶ Correct Answer : 10/16,  62.5%
  • - Ansung Public Health Center, Il-Jook branch, Korea Joon Woo Lee
  • - Asan Medical Center, Korea Seoung Soo Lee
  • - Bharat Scans, Chennai, India R G Gopinath
  • - Choong-ju Hospital Konkuk University, Korea Chang Hee Lee
  • - CHU Nancy-Brabois, France Denis Regent
  • - Harasanshin hospital, Fukuoka, Japan Shunya Sunami
  • - Korea Cancer Center Hospital, Korea Donghee Park
  • - Ospedale di Jesi, Italy Giancarlo Passarini
  • - Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
  • - Sungji Hospital, Korea Jung Hee Kim
▶ Semi-Correct Answer : 3/16,  18.8%
  • - Gochang Hospital, Korea Jiyong Rhee
  • - Inha University Hospital, Korea Dong-Jae Shim
  • - MH[CTC] Pune, India Vivek Sharma
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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