Pulmonary Mucormycosis: Risk Factors, Radiologic Findings, and Pathologic Correlation

• Published in: Radiographics Vol. 40; no. 3; pp. 656 - 666
• Main Authors: Agrawal, Rishi, Yeldandi, Anjana, Savas, Hatice, Parekh, Nishant D, Lombardi, Pamela J, Hart, Eric M
• Format: Journal Article
• Language: English
• Published: United States 01-05-2020
• Subjects: Combined Modality Therapy; Diagnosis, Differential; Humans; Immunocompromised Host; Lung Diseases, Fungal - diagnostic imaging; Lung Diseases, Fungal - immunology; Lung Diseases, Fungal - pathology; Lung Diseases, Fungal - therapy; Mucormycosis - diagnostic imaging; Mucormycosis - immunology; Mucormycosis - pathology; Mucormycosis - therapy; Risk Factors
• ISSN: 0271-5333; 1527-1323
• DOI: 10.1148/rg.2020190156

Pulmonary mucormycosis (PM) is an uncommon fungal infection most often seen in immunocompromised patients. The fungus grows on decaying food, soil, and animal excrement. Patients usually become infected by inhalation of spores. The most common risk factors include diabetes mellitus, hematologic malignancy, and solid organ or stem cell transplant. PM can have a nonspecific appearance at imaging. For example, early imaging may show peribronchial ground-glass opacity. Later, the disease progresses to consolidation, nodules, or masses. Because patients are usually immunocompromised, the differential diagnosis often includes invasive pulmonary aspergillosis (IPA). Various radiologic findings suggestive of PM have been identified to help differentiate it from IPA. For example, the reverse halo sign is more closely associated with PM than with IPA. The reverse halo sign is an area of ground-glass opacity surrounded by a rim of consolidation. In addition, the presence of pleural effusions and more than 10 nodules is more suggestive of PM than it is of IPA. PM can progress rapidly in neutropenic patients. Identification of the hyphae in tissue by using endobronchial or percutaneous sampling can allow differentiation from IPA and help confirm the diagnosis of mucormycosis. Because of the high mortality rate associated with PM, early identification of the disease is critical for an improved likelihood of survival. A multimodality treatment approach with antifungal agents and surgical débridement has been shown to improve outcomes. The authors review the risk factors for PM, describe its imaging appearance and disease process, and describe the treatment of the disease.
RSNA, 2020.