Pseudoaneurysm of pulmonary artery in mucormycosis. Radiographic characteristics and management.
Pulmonary mucormycosis is a rare and almost invariably fatal complication that can occur in the context of severe deficits in host defenses. Antemortem diagnosis is difficult and requires a high index of suspicion together with invasive diagnostic techniques. Mucor species exhibit a pronounced affinity to invade vessels; mucormycosis involving the pulmonary vasculature has rarely been documented antemortem, and survival in this context has been rare. In this report, we describe a patient with chronic renal failure and systemic lupus erythematosus who developed extensive invasion of the left main pulmonary artery by mucormycosis. Chest computed tomographic (CT) scans and pulmonary arteriogram demonstrated a massive pseudoaneurysm of the left pulmonary artery; these radiographic findings have not previously been described in mucormycosis. Aggressive combination therapy, employing preoperative amphotericin B (AmB) followed by surgical resection (pneumonectomy) and a full course of AmB, was curative. This favorable outcome supports the role of surgery as adjunctive therapy, and it underscores the need for early diagnosis and aggressive treatment.
Coffey
M J
MJ
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0360.
Fantone
J
J
Stirling
M C
MC
Lynch
J P
JP
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D000792:Angiography; D003131:Combined Modality Therapy; D006801:Humans; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging* / Q000628:therapy; D008297:Male; D009091:Mucormycosis / Q000000981:diagnostic imaging* / Q000628:therapy; D011651:Pulmonary Artery; D014057:Tomography, X-Ray Computed
D000666:Amphotericin B