What is the role of imaging studies in the workup of pulmonary mucormycosis (zygomycosis)?

Updated: Jul 06, 2021
  • Author: Avnish Sandhu, DO; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Chest radiography is often the initial test performed; however, its sensitivity and specificity for mucormycosis are low. Nonenhanced high-resolution CT scanning is the imaging modality of choice. [28] The most common findings include pleural effusion, nodules, consolidation, and ground-glass opacities. [59] With disease progression, consolidation can become multilobar. The reverse halo sign (ie, a nodule with central ground-glass opacity and a ring of peripheral consolidation) strongly suggests pulmonary mucormycosis and is rarely seen in invasive aspergillosis. [74] The halo sign (ie, a nodule surrounded by ground-glass opacity) represents a lung infarct surrounded by alveolar hemorrhage; it is associated with invasive mold infections but can be present in bacterial or viral infections and noninfectious lung disease (eg, Wegener granulomatosis, sarcoidosis, malignancy). [28] Other findings such as the air crescent sign and hypodense sign are less specific and may occur in later stages. 

Chest computed tomography (CT) scan showing pulmonary mucormycosis with left basal consolidation and widespread nodules due to Rhizopus oryzae infection. The patient was receiving cytotoxic chemotherapy for myelodysplastic syndrome and had iron overload from numerous blood transfusions.

Chest computed tomography (CT) scan showing pulmon Chest computed tomography (CT) scan showing pulmonary mucormycosis with left basal consolidation and widespread nodules due to Rhizopus oryzae infection. The patient was receiving cytotoxic chemotherapy for myelodysplastic syndrome and had iron overload from numerous blood transfusions.

Pulmonary mucormycosis in a patient with SARS-CoV-2 infection. Courtesy of Dr Sujata Rege.

Pulmonary mucormycosis in a patient with SARS-CoV- Pulmonary mucormycosis in a patient with SARS-CoV-2 infection. Courtesy of Dr Sujata Rege.

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