대한흉부영상의학회 Weekly Chest Cases

Case No : 990 Date 2016-10-17

Courtesy of Een Young Cho, M.D., KyungWon Doo, M.D / Inje university Haeundae Paik hospital
Age/Sex 54 / F
Chief ComplaintGeneral weakness. The patient had a history of diabetes and received kidney transplantation.

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Diagnosis With Brief Discussion

Diagnosis: Pulmonary Mucormycosis
Radiologic Findings: Chest AP view shows cavitary consolidation in right lower lung field and consolidation with CPA blunting in left lower lung field.
On CT scan, round consolidation with central GGO (reversed halo sign) and cavitary lesion was noted in the right lower lobe. Also bilateral pleural effusion was seen.
On bronchoscopic biopsy, fungal hyphae suggesting mucormycosis was revealed.
Brief Review: Mucormycosis is an opportunistic infection caused by fungi of the class Zygomycetes. Immunocompromised patients with diabetes, hematologic malignancies or undergone transplantation could be fatal. Pulmonary mucormycosis is 2nd most common manifestation, involving lung parenchyma and airways. Angioinvasion of fungi may cause thrombosis of pulmonary vessels and parenchymal necrosis. Radiologic findings of consolidation, solitary or multiple nodules with or without cavitation, halo or reversed-halo sign, pleural effusion and lymphadenopathy are shown, mostly nonspecific.
To distinguish mucormycosis from aspergillosis is important due to difference treatment by two fungal infections. Reversed-halo sign and cavitary lesion noted more frequently in pulmonary mucormycosis than invasive pulmonary aspergillosis.
The overall mortality rate of pulmonary mucormycosis is 45%, and patients treated with combined medical-surgical approach have better outcomes than those treated conservatively.
References: J H Chung, J D Godwen, J W Chien, et al. Pulmonary mucormycosis, Radiology 2010;256:667-670
J Jung, M Y Kim, H J Lee, et al. Cimparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis. Clin Microbiol Infect 2015;21:684.el1-684.dl8
S Chong, K S Lee, C A Yi, et al. Pulmonary fungal infection: Imaging findings in immunocompetent and immunocompromised patients , EJR 2006;59:371-383
Keywords: Lung, Infection, Fungal infection,

No. of Applicants : 91

▶ Correct Answer : 44/91, 48.4%

- The University of Tokyo Hospital , Japan Akifumi Hagiwara
- Department of Radiology, Seoul National University Bundang Hospital , Korea (South) Sung Hyun Yoon
- Samsung Medical Center , Korea (South) Boda Nam
- The University of Tokyo Hospital , Japan Toshihiro Furuta
- Kyungpook national university , Korea (South) Chungeun Lim
- Narayana Multispeciality Hospital Jaipur Raj , India JAINENDRA JAIN
- The Jikei university , Japan Taku Gomi
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- Maternity & child hospital , Saudi Arabia Sania ALBlushi
- Pusan national university hospital , Korea (South) Minkyu Kwak
- Kyungpook national university hospital, Korea , Korea (South) Sung Jun Moon
- The University of Tokyo Hospital , Japan Yusuke Watanabe
- SNUH , Korea (South) Juil Park
- Seoul National University Hospital , Korea (South) Sunkyung Jeon
- privato , Italy genchi enzo
- Seoul national university , Korea (South) Boram Kim
- KUMC ansan , Korea (South) Choo jiyung
- Kyoto University , Japan Akihiko Sakata
- SNUH , Korea (South) TAE HYUNG KIM
- University of Tsukuba, Dept of Radiology , Japan Manabu Minami
- University of Tsukuba Hospital , Japan Hiroaki Takahashi
- Saitama-Sekishinkai Hosptal , Japan Mihoko Yamazaki
- Maimonides Medical Center , United States naomi twersky
- The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
- Beaulieu clinic Geneva , Switzerland gilles GENIN
- the first affiliatited hospital of nanjing medical univercity , China Hai Xu
- Gifu University Hospital , Japan Yo Kaneko
- Asan Medical Center , Korea (South) Hyung Jung Koo
- Max Hospital New Delhi , India Rajesh Gothi
- , Korea (South) Seon-Young Park
- Shiga University of Medical Science , Japan Akitoshi Inoue
- James Paget Hospital , U.K , United Kingdom nabil mahmood
- 異⑸ , Korea (South) Junghwan Kim
- chungbuk national university hospital , Korea (South) lee jung hwan
- Chung buk national university hospital , Korea (South) hong Byun
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Chungbuk national university , Korea (South) Yong Kim
- CHU Poitiers , France CHAN paul
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- The University of Tokyo Hospital , Japan Kaoru Sumida
- Ajou University Hospital , Korea (South) Youngjin Yoo
- Ajou university hospital , Korea (South) DONGHYUN LEE
- Kyung Hee University Hospital at Gangdong , Korea (South) Han Na Lee
- Ajou university hospital , Korea (South) Pae Sun Suh

▶ Correct Answer as Differential Diagnosis : 12/91, 13.2%

- 以 , Korea (South) Jang Won
- Seoul national university hospital , Korea (South) Kumju Chae
- McGill University Health Center , Canada Alexandre Semionov
- Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Ajou University Hospital , Korea (South) Seulgi You
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- ROKAF 10th Fighter Wing , Korea (South) Kun Woo Kang
- chungbuk national university hospital , Korea (South) soojung lee
- Private sector , Greece Vasilios Tzilas
- ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
- Medicheck health care , Korea (South) Chae Lim

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 990 Date 2016-10-17

Discussion

No. of Applicants : 91