CTICasesPulmonary Mucormycosis (Rhizopus) with Bird's Nest Sign
Imaging findings
CT in a patient with relapsed ALL and prior lung adenocarcinoma demonstrates rapid progression of a right middle lobe consolidation over days. The sagittal view reveals a complete dense rind of consolidation surrounding a more lacy or ground-glass center, producing the bird's nest sign: a dense peripheral ring with central lacy content. The earlier CT showed a more discrete central nodule with surrounding lower-grade opacity, initially interpreted as possible hemorrhage adjacent to an angio-invasive nodule. Bronchoscopy showed minimal blood, inconsistent with hemorrhage explaining the volume of white consolidation. Bronchoscopic specimen confirmed Rhizopus.
Key takeaways
The bird's nest sign on CT — a dense peripheral consolidative rind surrounding a central lacy or low-grade opacity — is a characteristic appearance of mucormycosis (specifically Rhizopus) in an immunosuppressed patient. This pattern is best demonstrated on sagittal reformats which reveal the complete circumferential rind around the central lacy material. When an angio-invasive pattern of consolidation with rapid progression is identified on sagittal imaging as a complete rind rather than just a dense nodule with surrounding opacity, mucor/Rhizopus should be favored over aspergillus, which would be an important management distinction.
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