Imaging Conference Cases
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Case No : 6
- Age/Sex 52 / F
- Case Title Cough with sputum for 45 days She have been suffered type 2 diabetes for 15 years. Diabetes are not totally controlled with oral hypoglycemic agents.
Discussion
Diagnosis With Brief Discussion
- Courtesy
- C
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- Imaging Findings
Diffuse circumferential peribronchial soft tissue lesion
- poor enhancement
- smooth luminal narrowing
- mottled air densities
Right middle lobe and lower lobe atelectasis
Centrilobular nodules
Mediastinal lymphadenopathy
Pleural effusion
- Differential Diagnosis
- Focal airway narrowing
- Stricture
- Tuberculosis
- Wegener’s granulomatosis
- Papillomatosis
- Benign or malignant neoplasm
- Other infection
- coccidiodomycosis, histoplsmosis, mucormycosis, aspergillosis, Klebsiella rhinoscleromatis
Diffuse airway narrowing
- Relapsing polychondritis
- Amyloidosis
- Tracheobronchopathia osteochondroplastica
Malignant neoplasm
- Adenoid cystic carcinoma
Tuberculosis
Other infection
- Mucormycosis, Aspergillosis
Infective agents
- Fungi of class Zygomycetes order Mucorales
- Hyphae of zygomycetous fungi
- broad
- irregularly branch, right angle
- rare septations
ex)Aspergillus: narrower, regular branching, and many septations
Type of infection
- Opportunistic
Pathology
- Ischemic or hemorrhagic necrosis of host tissues that results from invasion of vasculature by hyphae
Predisposing conditions
- DM
- Hematologic malignancy
- Solid organ transplantation
- Severe burns
- Deferoxamine therapy
Clinical subsets
- Rhinocerebral
- Pulmonary(30%, 2nd M/C)
- Abdomino-pelvic
- Cutaneous (burn patients)
- Disseminated
Clinical manifestion
- Occasionally asymtomatic in DM Pt.
- Cough, fever, chest pain, hemoptysis
- Progressive respiratory failure
- Mortality without aggressive early treatment 80%
Chest radiographic findings
- Lobar or segmental consolidation either unifocal or multifocal
- Solitary or multiple nodules
- Cavitation frequent
- Air crescent sign
- Pleural effusion
- Rapid progression
Chest CT findings
- Central low attenuated lesion: necrosis
- Halo sign around nodules
- Endobronchial mass
- Hilar and mediastinal adenopathies
- Pulmonary artery pseudoaneurysm
Striking predilection for DM
CT findings
- Enhancing areas of mural thickening
- Luminal narrowing
- Intramural air
- Low-attenuation nonenhancing bronchial wall thickening
- Bronchonodal fistular formation
J Thorc Imaging 1999 Jul; 14(3):210-4
Treatments
- Early surgical intervention
- Antifungal therapy with amphotericin B
- Amphotericin B: usuallly 1- 1.5mg / kg a day
- Control of predisposing factors
- Hyperglycemia, metabolic acidosis, and neutropenia
- Medical treatment alone : mortality 68%
- Surgical therapy : mortality 11%
