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Weekly Chest CasesArchive of Old Cases

Case No : 1135 Date 2019-07-30

  • Courtesy of Hyeon Jun Jang, Kyung Min Shin / Kyungpook National University Chilgok Hospital
  • Age/Sex 14 / F
  • Chief ComplaintFever, blood tinged sputum, ALL patient on chemotherapy
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Tracheobronchial mucormycosis
Radiologic Findings
Fig 1~2. Contrast-enhanced CT images show low density nodule in the upper trachea with mediastinal fat invasion.
Fig 3~5. Contrast-enhanced CT images show nodular, enhancing wall thickening of the trachea and right main bronchus.
Bronchoscopic exam showed diffuse narrowing with white-brownish pseudomembrane. The growth of Mucormycosis was observed in the bronchial washing specimen. The patient died of massive hemoptysis.

Expectorated material during massive hemoptysis

Brief Review
Identification of tracheobronchial mucormycosis is usually delayed and ultimately made via autopsy because of the nonspecific clinical presentations. However, serious complications do develop during mucormycosis because the pathogen invades the airways and hilar vessels which may result in atelectasis, abscess formation and hemorrhage.


Endobronchial involvement is a rare presentation of mucormycosis. Its lesions have been identified as gray-white mucoid materials that frequently block major airways, which are themselves often edematous and necrotic. CT scans of endobronchial mucormycosis showed luminal narrowing and wall thickening of the mid- or distal trachea and bronchi, variably sized mediastinal lymph nodes, nonspecific pulmonary opacities, and a large lung abscess. Also identified were intramural air collections within the thickened bronchial wall, nonenhancing low attenuation thickening of the bronchial wall, and bronchonodal fistula.


In a previous study of 12 mucormycosis cases, 95% of patients had immunosuppressive diseases such as Diabetes mellitus with or without ketoacidosis, corticosteroid therapy, and renal insufficiency. A majority of pathological diagnoses were made via a transbronchial biopsy (76.7%). However, bronchoscopic biopsy itself can be catastrophic owing to the high risk of fatal hemorrhage. In conclusion, tracheobronchial mucormycosis is a rare but severe disease with high mortality due to nonspecific clinical presentations and variable predisposing factors.
Please refer to
Case 735,
KSTR Imaging Conference 2006 Spring  Case 6,
References
1. Report of 12 cases with tracheobronchial mucormycosis and a review. He R, Hu C, Tang Y, Yang H, Cao L, Niu R. Clin Respir J. 2018;12:1651–1660
2. Mucormycosis of the central airways: CT findings in three patients. Kim KH, Choi YW, Jeon SC, Shin DH, Jung JI, Seo HS, Hahm CK. J Thorac Imaging. 1999 Jul;14(3):210-4
Keywords
Airway, Fungal infection, Mucormycosis,

No. of Applicants : 62

▶ Correct Answer : 1/62,  1.6%
  • - , Korea (South) JAEHEUNG BAE
▶ Correct Answer as Differential Diagnosis : 22/62,  35.5%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Ajou University School of Medicine , Korea (South) JUNG YONG JUN
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - Private sector , Greece VASILIOS TZILAS
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
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