CTICasesDisseminated Fungal Infection with Spontaneous Pneumomediastinum
▶ Watch on YouTube — age-restricted, cannot embed here
Imaging findings
Chest CT shows a highly unusual, peripheral and subpleural distribution of dense ground-glass and consolidative opacities, primarily in the lower lung zones. Follow-up imaging shows persistent opacities, a massive spontaneous pneumomediastinum, a pneumothorax, and subcutaneous emphysema. On high-resolution CT, air is seen dissecting along the interlobular septa of the anterior lung, consistent with the Macklin phenomenon. Autopsy confirmed a disseminated fungal infection with yeast and hyphae in the lungs, brain, brainstem, and urine.
Key takeaways
High-dose corticosteroid therapy can lead to devastating, disseminated fungal infections with highly atypical pulmonary presentations, such as persistent, peripheral subpleural consolidations that mimic interstitial lung disease. Rupture of alveoli under pressure can lead to spontaneous pneumomediastinum via the Macklin phenomenon, with air dissecting along the bronchovascular bundles and interlobular septa into the mediastinum, neck, and subcutaneous tissues.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Mediastinal Teratoma Mimicking Pericardial CystNeoplastic
- Unilateral Pleural Metastasis from OsteosarcomaNeoplastic
- Metastatic Pulmonary CalcificationMetabolic
- Sternal MRSA OsteomyelitisInfection
- Pseudoaneurysm and Transient Aortic Occlusion following Coarctation RepairVascular
- Multifocal Lung AdenocarcinomaNeoplastic
- Centrilobular Emphysema Mimicking LymphangioleiomyomatosisExposure
- Post-Pneumonectomy Bronchopleural Fistula and EmpyemaIatrogenic
See all cases from March 24, 2014 →
Related Infection cases
- Acute Mediastinitis caused by Streptococcus pyogenes
- Human Metapneumovirus Infection causing Acute Respiratory Distress Syndrome
- Cytomegalovirus Infection with a Miliary Pattern in a Kidney Transplant Recipient
- Blastomycosis Mimicking Community-Acquired Pneumonia
- Disseminated Blastomycosis with a Miliary Pattern
- Pulmonary Blastomycosis mimicking community-acquired pneumonia