Analysis of chest CT findings, diagnosis, and treatment of mucormycosis infection in 65 hematologic disease patients

doi:10.16150/j.1671-2870.2024.05.005

Abstract

Abstract:

Objective This study aims to analyze the clinical diagnosis and treatment characteristics of mucormycosis infection in hematologic disease patients for clinical reference. Methods A total of 65 consecutive cases of hematologic diseases with mucormycosis, clinically diagnosed at our hospital from October 2018 to December 2023, were included. All patients underwent chest CT examination, and 14 of them underwent cranial MRI examination. Eight patients underwent lung tissue biopsy, and 57 underwent blood, alveolar lavage fluid, or tissue metagenomic next-generation sequencing. The CT findings were analyzed and the diagnostic process was summarized. Results Pulmonary mucormycosis accounted for 5.30% (65/1 233 cases) of all fungal infections diagnosed in our hospital during the same period. Among these patients, 58 had pulmonary mucormycosis, and 7 had disseminated mucormycosis involving multiple organs. Chest CT of patients with pulmonary mucormycosis manifested in the following four types: single large patchy consolidation (23/65), multiple nodules (28/65), patchy consolidation-nodules mixed type (11/65), diffuse exudation in the lungs (3/65), with 29 cases showing reverse halo sign, 25 cases showing halo sign, 20 cases with pleural effusion, 11 cases with more than 10 nodules, and 2 cases with vessel cut-off sign on enhanced CT examination. In patients with disseminated mucormycosis, there were 7 cases of multiple nodules in the lung, 6 cases of single or multiple nodules in the brain, 1 case of diffuse infarction in the brain, and 2 cases of nodules in the spleen and kidney. The average time from the first chest CT to clinical diagnosis was (4.3±1.8) days. As CT scan suggested suspected fungal infection, blood, tissue and bronchoalveolar lavage fluid mNGS were performed. After antifungal treatment, such as amphotericin B, 58 patients improved, 2 patients underwent surgical resection of lung tissue, 2 patients were lost to follow-up after their family members decided to forgo treatment, and 3 patients died. Conclusions Pulmonary mucormycosis accounts for about 5% of fungal infections in hospitalized patients with hematological diseases. Chest CT mainly shows single large patchy consolidation and multiple nodules, with 44.6% showing reverse halo sign and 38.5% showing halo sign. These signs can provide reference for diagnosis, and mNGS plays an important role in clinical diagnosis.

Key words: Hematologic diseases, Mucormycosis, Computed tomography

CLC Number:

R519

LI Ying, JIANG Han, WANG Xiaoxue, WEI Haonan. Analysis of chest CT findings, diagnosis, and treatment of mucormycosis infection in 65 hematologic disease patients[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(05): 494-499.

Figures/Tables 3

Table 1

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Thoracic CT manifestations	Cases	Reversed halo syndrome	Halo syndrome	Pleural effusion
Single large patchy consolidation	23（35%）	18（78%）	0	10（43%）
Multiple nodules	28（43%）	0	25（89%）	20（71%）
Mixed	11（17%）	8（73%）	0	2（18%）
Diffuse exudative type	3（5%）	3（100%）	0	2（67%）