CTICasesPulmonary mucormycosis (Rhizopus) with bird's nest sign
Imaging findings
CT scan of a neutropenic leukemic patient on voriconazole prophylaxis demonstrates a rapidly developing, spherical consolidation in the lower lobe. Follow-up scan a few days later reveals a classic bird's nest sign, consisting of a dense outer rind of consolidation surrounding a lacy, necrotic center.
Key takeaways
The bird's nest sign (or reverse halo sign) is highly suggestive of angioinvasive fungal infections like mucormycosis (Rhizopus) in neutropenic patients. Breakthrough infections can occur despite voriconazole prophylaxis and may require surgical resection (lobectomy).
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