CTICasesAngioinvasive Mucormycosis (Rhizopus) with Aspergillus Co-infection
Imaging findings
In a patient with multiple myeloma and healed pathologic fractures, serial imaging shows progressive bibasilar consolidation, small-airways nodules with a tree-in-bud pattern in the upper lobes, and a large right basal consolidation with a dense peripheral rim and lacy, necrotic center, a bird's-nest configuration, that fails to enhance with contrast; over time this lesion directly extends across the diaphragm into the liver, with a separate area of probable embolic splenic infarction.
Key takeaways
Cultures grew both Rhizopus (mucormycosis) and Aspergillus, and the necrotic, non-enhancing, bird's-nest consolidation with direct transdiaphragmatic invasion into the liver is a dramatic demonstration of how angioinvasive mucormycosis disregards normal anatomic boundaries, crossing pleura, diaphragm, and liver capsule while also inducing pulmonary infarction from vascular invasion; despite maximal antifungal therapy the patient did not recover counts and had a poor prognosis.
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