When are CT scans indicated in the workup of fungal pneumonia?

Updated: Jun 21, 2019
  • Author: Romeo A Mandanas, MD, FACP; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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CT scans should be obtained at the first hint of pulmonary infection in patients at risk of mucormycosis because of the high mortality in this patient population. In patients with hematological malignancies, several nonspecific findings have been proposed to differentiate mucormycosis from other infections, especially aspergillosis. These include the presence of multiple nodules and pleural effusions and the development of a “reversed halo,” which is a ground-glass attenuation in the center of a nodule with a surrounding zone of consolidation. [5, 30] The reversed halo sign is not exclusive to mucormycosis; it might also be found in patients with paracoccidioidomycosis, histoplasmosis, cryptococcosis, [30] and even nonfungal causes like tuberculosis and sarcoidosis. [31] In the setting of severe neutropenia however, it warrants a high suspicion for pulmonary mucormycoses [32] and initiation of appropriate empiric treatment while awaiting culture results.

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