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Weekly Chest CasesArchive of Old Cases

Case No : 1493 Date 2026-06-01

  • Courtesy of Hyun-ju Lim, Kun Young Lim, Hyae Young Kim / National Cancer Center
  • Age/Sex 69 / M
  • Chief ComplaintCough, sputum and myalgia
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Pulmonary mucormycosis
Radiologic Findings
Fig 1. Chest PA shows mass like consolidation with internal cavity in the right lung..
Fig 2. Axial chest CT image reveals a consolidation with an area of central ground glass opacity (reverse halo sign) in the right lower lobe.
Fig3. Coronal chest CT image shows mass like consolidation in the right lower lobe extending to the right upper lobe with reverse halo sign and internal cavitation.
Brief Review
The patient underwent bronchoscopic biopsy in the right lower lobe superior segment. Acute inflammation with degenerated fungal hyphae, morphologically consistent with mucormycosis was confirmed. A culture of the specimen showed mycotic strutures consistent with the genus Rhizopus.
Mucormycosis is an invasive fungal infection that is encountered primarily in patients with a high degree of immunosuppression. The risk factors for mucormycosis include uncontrolled DM, hematologic malignancy (acute leukemia in particular), stem cell transplant, solid transplant, neutropenia, deferoxamine therapy, and corticosteroid use. Pulmonary mucormycosis (PM) is the second common form of presentation, after rhinocerebral mucormycosis. Symptoms of PM include fever, cough, chest pain, and dyspnea.
The appearance of PM at imaging is varied and nonspecific. In early PM, initial CT simply show a perivascular ground glass lesion prior to the development of more extensive image finding. Ground glass lesions usually progress to lobar or multilobar consolidation, nodules, or masses. The reverse halo sign (RHS) is characterized by a central ground glass opacity with a peripheral ring of consolidation on CT . Distinguishing between angioinvasive aspergillosis and PM based on CT findings alone is difficult. Features that are more suggestive of PM include the presence of multiple nodules (≥10), pleural and the RHS.
At histologic examination, Mucormycosis hyphae are broad and irregular with right-angled branching, as oppsed to Aspergillus hyphae, which are thinner with more acute angled branching. In addition, one of the hallmarks of PM is hyphal invasion of large and small blood vessels, resulting in thrombosis and infarction.
References
1. Agrawal R, Yeldandi A, Savas H, Parekh N, Lombardi P, Hart E. Pulmonary mucormycosis: risk factors, radiologic findings, and pathologic correlation. Radiographics 2020;40:656-666
2. Buritica L, Urueta A,. Pulmonoary muicormycosis. NEJM 2021;384:18
3. Alexander B, Lamoth F, Heussel C, Prokop C, Desai S, Morrissey C. Baddley J. Guidance on imaging for invasive pulmonary aspergillosis and mucormycosis: from the imaging working group for the revision and update of the consensus definitions of fungal disease from the CORTC/MSGERC. Clinical Infectious Disease 2021;72(S2):79-88
4. Godoy M, Pria H, Truong M, Shroff G, Marom E. Invasive fungal pneumonia in immunocompromised patients. Rdiol Clin N Am 2022; 60:497-506
Keywords

No. of Applicants : 78

▶ Correct Answer : 26/78,  33.3%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Teikyo University Hospital , Japan ISSEI FUKUDA
  • - , Japan HIROKI SAKURADA
  • - Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
  • - Kyeongpook National University Hospital , Korea (South) JUNGMIN LEE
  • - Other , Korea (South) SEONGSU KANG
  • - Asan Medical Center , Korea (South) YUJEONG EO
  • - , China FANG YING GEN
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Seoul Medical Center , Korea (South) HATAEK JEONG
  • - QATIF CENTRAL HOSPITAL , Saudi Arabia HANI M ALSALAM
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Chonbuk National University Hospital , Korea (South) JUNGHOON OH
  • - Otsu Red Cross Hospital , Japan JUN YOSHIDA
  • - Chonbuk National University Hospital , Korea (South) YEEUN LEE
  • - Other , Korea (South) CHAEHUN LIM
  • - , Korea (South) HEONSEOK LEE
  • - Chonnam National University Hospital , Korea (South) SANGYONG BAK
  • - Seoul Medical Center , Korea (South) HANSEUL CHO
  • - , Japan TOMOHIRO KAWAJI
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Ehime University , Japan TOMOHISA OKADA
  • - Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 13/78,  16.7%
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Kyoto University Hospital , Japan YUSUKE UTSUNOMIYA
  • - , Italy PAOLO BALDASSARI
  • - The Catholic University of Korea Seoul St. Mary , Korea (South) JIHO PARK
  • - Teikyo University Hospital, Mizonokuchi , Japan TOSHIHIRO FURUTA
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) OHMIN KWON
  • - Etlik City Hospital, Ankara , Turkey MERIC TUZUN
  • - Fukuoka university , Japan KEISUKE SATO
  • - Ehime University , Japan KOTARO MATSUMOTO
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - , Japan YUJI OHIZUMI
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Current Editor : Eui Jin Hwang, M.D., Ph.D Email : weeklychestcases@gmail.com

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