CTICasesAngioinvasive Mucormycosis
Imaging findings
A neutropenic patient with a hematologic malignancy on chemotherapy has, in the lower lobes, an area of central lower attenuation developing a bird's-nest appearance, new from a prior PET/CT. Over weeks it evolved into a dense consolidation with a reverse halo (infarct-like) appearance, and on contrast imaging the pulmonary arteries are lost through the lesion without a discrete macroscopic occlusion. Biopsy confirmed mucor with vascular invasion and necrotic lung.
Key takeaways
Angioinvasive mucormycosis in a neutropenic patient produces an evolving area of infarcted lung with a bird's-nest and reverse-halo appearance and loss of the traversing pulmonary arteries from vascular invasion. Distinguishing mucor from aspergillus or other fungi is clinically important, as it changes antifungal therapy (for example, amphotericin), and biopsy confirms angioinvasion.
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