CTICasesMixed Fungal Infection with Mucormycosis "Bird's Nest" Sign, Aspergillus Abscess, and Candida
Imaging findings
A neutropenic patient had a radiograph showing a rounded peripheral consolidative opacity with a reverse-halo, "bird's nest" appearance, plus scattered central ovular nodules elsewhere in the lungs; follow-up contrast-enhanced CT a few days later showed similar findings with abrupt cutoff of vessels feeding the lesion, which crossed the fissure to involve both the right middle and right upper lobes. Despite a prior positive Aspergillus PCR from bronchoscopy, VATS resection confirmed the dominant process was mucormycosis producing the classic bird's-nest morphology, with a focal small Aspergillus abscess and incidental Candida also identified within the specimen; scattered persistent small nodules elsewhere proved to be metastatic papillary thyroid carcinoma.
Key takeaways
The bird's-nest sign with a reverse halo remains a reliable indicator that mucormycosis is the dominant fungal process even when a positive Aspergillus PCR is also present, since more than one organism (here Mucorales, Aspergillus, and Candida) can coexist within the same resected specimen; this case underscores that a positive test for one fungal organism does not exclude a different, more aggressive fungal infection driving the dominant radiologic pattern.
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