CTICasesAngioinvasive Mucormycosis in an Immunosuppressed Heart Transplant Recipient
Imaging findings
An initial chest radiograph shows subtle consolidation over the right hilum, more posterior (superior segment right lower lobe). Follow-up CT shows a wedge-shaped consolidation (infarct-like) that rapidly progresses to central cavitation and necrosis with small air bronchograms. Although small pulmonary emboli were noted in a different segment, the primary lesion evolved with necrosis. CT-guided biopsy and subsequent right lower lobectomy confirmed Mucormycosis. Abrupt arterial cut-off in the feeding vessels was noted, a sign often associated with angioinvasive fungal disease.
Key takeaways
Immunosuppressed patients, especially organ transplant recipients, are at high risk for invasive fungal infections. Angioinvasive fungal infections like Mucormycosis can present as wedge-shaped consolidations that rapidly progress to necrosis and cavitation, mimicking infarction due to vascular invasion. Abrupt arterial cut-off can be a radiographic sign of angioinvasive fungal disease. Biopsy is crucial for definitive diagnosis, even when initial diagnostic yields are expected to be low.
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