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Pulmonary mucormycosis: serial morphologic changes on computed tomography correlate with clinical and pathologic findings

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Abstract

Purpose

To evaluate serial computed tomography (CT) findings of pulmonary mucormycosis correlated with peripheral blood absolute neutrophil count (ANC).

Materials and methods

Between February 1997 and June 2016, 20 immunocompromised patients (10 males, 10 females; mean age, 48.9 years) were histopathologically diagnosed as pulmonary mucormycosis. On initial (n=20) and follow-up (n=15) CT scans, the patterns of lung abnormalities and their changing features on follow-up scans were evaluated, and the pattern changes were correlated with ANC changes.

Results

All patients were immunocompromised. On initial CT scans, nodule (≤3cm)/mass (>3cm) or consolidation with surrounding ground-glass opacity halo (18/20, 90%)) was the most common pattern. On follow-up CT, morphologic changes (13/15, 87%) could be seen and they included reversed halo (RH) sign, central necrosis, and air-crescent sign. Although all cases did not demonstrate the regular morphologic changes at the same timeline, various combinations of pattern change could be seen in all patients. Sequential morphologic changes were related with recovering of ANC in 13 of 15 patients.

Conclusion

Pulmonary mucormycosis most frequently presents as consolidation or nodule/mass with halo sign at CT. Morphologic changes into RH sign, central necrotic cavity or air-crescent sign occur with treatment and recovery of ANC.

Key points

• Pulmonary mucormycosis showed various CT-morphology including CT halo sign

• Pulmonary mucormycosis had trends of serial morphologic changes on follow-ups

• Recovery of absolute neutrophil count changed CT-morphology of mucormycosis in immune-compromised patients

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Abbreviations

AML:

acute myeloid leukaemia

ANC:

absolute neutrophil count

CKD:

chronic kidney disease

DM:

diabetes mellitus

IPA:

invasive pulmonary aspergillosis

RH:

reversed halo

PM:

pulmonary mucormycosis

VATS:

video-assisted thoracoscopic surgery

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Authors and Affiliations

  1. Department of Radiology and Centre for Imaging Science, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea

    Bo Da Nam, Tae Jung Kim, Kyung Soo Lee, Tae Sung Kim & Myung Jin Chung

  2. Department of Pathology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea

    Joungho Han

Authors
  1. Bo Da Nam
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  2. Tae Jung Kim
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  3. Kyung Soo Lee
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  4. Tae Sung Kim
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Correspondence to Tae Jung Kim.

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Guarantor

The scientific guarantor of this publication is Tae Jung Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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The authors state that this work has not received any funding.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Nam, B., Kim, T.J., Lee, K.S. et al. Pulmonary mucormycosis: serial morphologic changes on computed tomography correlate with clinical and pathologic findings. Eur Radiol 28, 788–795 (2018). https://doi.org/10.1007/s00330-017-5007-5

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  • DOI: https://doi.org/10.1007/s00330-017-5007-5

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