PMC5760874_01
(a) X-ray chest showing right parahilar opacity, (b) contrast-enhanced computer tomography chest showing right hilar mass compressing intermediate bronchus, (c) fiber-optic bronchoscopy showing thick whitish necrotic material filling right intermediate and lower lobe bronchi, (d) bronchial biopsy showing aseptate acutely branching hyphae suggestive of mucormycosis
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F1
Chest X-ray revealed right parahilar opacity [Figure 1a] and contrast-enhanced computed tomography chest showed right hilar mass compressing intermediate bronchus [Figure 1b]. Immediately, postadmission patient had massive hemoptysis and was transferred to respiratory intensive care for stabilization, following which fiber-optic bronchoscopy was done revealing thick whitish necrotic material filling right intermediate and lower lobe bronchi [Figure 1c]. Bronchial biopsy confirmed aseptate acutely branching hyphae suggestive of mucormycosis [Figure 1d].
(a) Repeat computer tomography chest showing collapse consolidation of right lower lobe with right-sided moderate pleural effusion, (b) medical thoracoscopy image showing thick pleura over both parietal and visceral surfaces with blackish deposits, (c) biopsy of parietal pleura showing fungal invasion by Mucorales, (d) pneumonectomy specimen showing extensive necrosis with Mucorales
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F2
However, he continued to have high-grade fever with chills and repeat CT chest revealed collapse consolidation of right lower lobe with right-sided moderate pleural effusion [Figure 2a]. Biopsy of parietal pleura demonstrated fungal invasion by Mucorales [Figure 2b and c]. Pneumonectomy specimen showed extensive necrosis with nonseptated hyphae [Figure 2d], and third antifungal micafungin was also added.