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%

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

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

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

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 990 Date 2016-10-17

Discussion

No. of Applicants : 91