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British Journal of Radiology (2006) 79, e88-e95
© 2006 British Institute of Radiology
doi: 10.1259/bjr/16038097
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Disseminated mucormycosis in haematological patients: CT and MRI findings with pathological correlation

M Horger, MD 1 H Hebart, MD 2 H Schimmel, MD 3 M Vogel, MD 1 H Brodoefel, MD 1 K Oechsle, MD 2 U Hahn, MD 4 M Mittelbronn, MD 5 W Bethge, MD 2 and C D Claussen, MD 1

Departments of 1Diagnostic Radiology 2Internal Medicine II 3Pathology 4Radiology 5Neuropathology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany


Figure 1
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  		Figure 1. A 34-year-old female patient with relapsing acute myelogenous leukaemia (AML) and progressive abdominal pain at severe neutropenia. (a) Segmental wall thickening of the sigmoid colon (white arrow) with 5 cm long stenosis is seen. (b) A contrast enhanced abdominal CT performed 4 days later, disclosed non-enhancing small and large bowel segments (white arrows). Note also the presence of ascites. (c) Axial contrast enhanced CT (CECT) scan of the pelvis shows hypodense area in the uterine body (white arrow) corresponding to necrosis. (d) Small intestinal wall vessel occlusion and transmural invasion by Rhizopus hyphae (white arrow) (periodic acid-Schiff (PAS) stain with x 200 magnification).

 

Figure 2
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  		Figure 2. A 62-year-old man with acute myelogenous leukaemia (AML) presented with fever and cough. Chest CT shows a large infiltration the right lower lobe, already extending into the middle lobe. (a) Good demarcation of a huge lung sequester (black arrow), surrounded by peripheral inflammation is seen on axial CT-scan. (b) Contrast enhanced CT (CECT) demonstrates the extent of pulmonary infarction (white arrow) by showing no contrast enhancement. (c) At histology, large area of lung parenchymal necrosis, due to invasion of large pulmonary vessels by fungi, was found. Thrombotic occlusion of pulmonary vessels (Elastica van Giesson stain x 200 magnification) due to Rhizopus hyphae (white arrow) are seen. Note also normally air filled neighbouring alveoli. (d) 10 days after erythematous lesions of the legs caused by mucormycosis had occurred; a fluid collection with ring enhancement (white arrow) was diagnosed in the left iliopsoas bursa.

 

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  		Figure 3. A 63-year-old female with relapsing multiple myeloma developed paraparesis following chemotherapy. (a) Fusiform enlargement of the spinal cord (white arrow) with increased T2 signal and diffusion restriction (not shown) were diagnosed 24 h later at MRI. (b) In the same session, MRI of the head disclosed areas of restricted diffusion in both occipital lobes representing acute parenchymal infarction (white arrows). (c) At autopsy, transversal sections through the thoracic spinal cord showed severe tissue softening and defects, especially in the central parts (white arrow). (d) Both lungs showed large areas of haemorrhagic infarction. Note also pulmonary vessel occlusion by fungi responsible for haemorrhagic infarction (white arrow).

 

Figure 4
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  		Figure 4. A 42-year-old man with acute myelogenous leukaemia (AML) and fever in neutropenia, following chemotherapy. (a) Chest CT revealed a solitary pulmonary nodule (white arrow) in the right upper lung lobe. (b) 3 months later, MRI (axial post-contrast T1 weighted spin echo (SE) scan) of the paranasal sinus region showed circular swelling of the mucosa of the left maxillary sinus with relatively low intensity on T2 weighted scans confined to small areas of the medial sinus wall (white arrow). (c) At follow up MRI (axial post-contrast T1 weighted SE scan) progression of local infection with involvement of the left orbit was diagnosed (white arrow). Note areas of non-enhancing tissue due to infarction. (d) Despite intensive antifungal therapy, contiguous bone permeation with extension of the fungal process to the frontal dura and frontal lobe (white arrow) was disclosed on axial post-contrast T1 weighted scan.

 




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