Lung resection from wedge to pneumonectomy as surgical options for pulmonary mucormycosis

Abstract

Pulmonary mucormycosis (PM) is a rare and life-threatening condition, most prevalent in immunocompromised patients. Early signs and symptoms are often nonspecific. A high index of suspicion in at risk patients should prompt early infectious work-up, including bronchoscopy, followed by aggressive antifungal therapy and early surgical resection when indicated. We demonstrate these core tenants of diagnosis and management of PM via two patient presentations, the first involving a kidney transplant recipient who presented with a mild cough, found to have a lung lesion with rapid growth over a few weeks; the second involving a patient with acute lymphoblastic leukemia who presented with hemoptysis and imaging revealing a 5 cm perihilar mass obliterating the left pulmonary artery. Both patients were managed with aggressive surgical therapy.

Keywords: immunosuppressed; leukemia; pulmonary mucormycosis; transplant.

Figure 1

Patient 1 pre-operative images showing rapid progression of disease. (A) Initial CT scan with a 2.4 cm LUL pulmonary nodule. (B) Repeat CT scan 28 days later showing rapid growth and cavitation of the mass, now measuring 7.1 cm.

Figure 2

Patient 2 pre-operative images. (A) Coronal section of CT angiogram showing LUL mass abutting the aortic arch and invading the left main pulmonary artery and left mainstem bronchus. (B) Axial CTA showing complete occlusion of the left pulmonary artery. (C) 3D reconstruction of CTA showing complete occlusion of the left pulmonary artery and lack of opacification of any pulmonary artery branches and pulmonary oligemia.

Figure 3

Patient 2 post-operative CT scan showing complete resection of disease and expected post-operative anatomical changes, including leftward deviation of mediastinum and hemidiaphragmatic elevation.