medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-2018-5-45-54medvis-654Research ArticleГРУДНАЯ КЛЕТКАTHORAXЛучевая диагностика мукормикоза легкихRadiological diagnosis of pulmonary mucormycosisКосичкинаА. Б.KosichkinaA. B.

врач-рентгенолог отделения лучевой диагностики, младший научный сотрудник научного отделения диагностической и интервенционной радиологии

197758, п. Песочный, Ленинградская область, Ленинградская ул., д. 68

radiologist at the Department of Radiology, junior researcher at the Department of Diagnostic and interventional radiology

197758, Pesochny, Leningrad region, Leningradskaya str., 68

akosichkina@gmail.comМищенкоА. В.MishchenkoA. V.

доктор мед. наук, заведующий научным отделением диагностической и интервенционной радиологии

doct. of med. sci., Head of the Department of Diagnostic and Interventional radiology

Professor of the Scientific Clinical and Educational Center “Radiation Diagnostics and Nuclear Medicine”

КулеваС. А.KulevaS. A.

доктор мед. наук, заведующая отделением химиотерапии и комбинированного лечения злокачественных опухолей у детей, ведущий научный сотрудник научного отдела инновационных методов терапевтической онкологии и реабилитации

doct. of med. sci., Head of the Department of Chemotherapy and combined treatment of pediatric malignancies, lead researcher at the Department of innovative methods of therapeutic oncology and rehabilitation

ДоровскихГ. Н.BurovikI. A.

доктор мед. наук, профессор кафедры лучевой диагностики ПДО, 

отделением лучевой диагностики

cand. of med. sci., radiologist at the Department of Radiology, senior researcher at the Department of Diagnostic and interventional radiology

БуровикИ. А.ArtemevaA. S.

канд. мед. наук, врач-рентгенолог отделения лучевой диагностики, старший научный сотрудник научного отделения диагностической и интервенционной радиологии

cand. of med. sci., Head of the Department of Pathology, Head of the Laboratory of the tumor morphology

АртемьеваА. С.PetrovaA. S.

канд. мед. наук, заведующая патологоанатомическим отделением, руководитель научной лаборатории морфологии опухолей

radiologist at the Department of Radiology

ПетроваА. С.GharibyanS. A.

врач-рентгенолог отделения лучевой диагностики, младший научный сотрудник научного отделения диагностической и интервенционной радиологии

resident at the Department of Radiology

ГарибянС. А.BoikoN. V.

ординатор отделения лучевой диагностики

radiologist at the Department of Radiology

БойкоН. В.KozyrevaK. S.

врач-рентгенолог отделения лучевой диагностики

radiologist at the Department of Radiology

КозыреваК. С.KalininP. S.

врач-рентгенолог отделения лучевой диагностики

cand. of med. sci., radiologist at the Department of Radiology, senior researcher at the Department of diagnostic and interventional Radiology

КалининП. С.DorovskikhG. N.

канд. мед. наук, врач-рентгенолог отделения лучевой диагностики, старший научный сотрудник научного отделения диагностической и интервенционной радиологии

doct. of med. sci., Professor, Department of Radiology of Postgraduate Education

Head of the Department of Radiology

ФГБУ “Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова”РоссияN.N. Petrov National Medical Research Center of OncologyRussian FederationФГБУ “Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова”РоссияN.N. Petrov National Medical Research Center of Oncology St. Petersburg State UniversityRussian FederationКафедра лучевой диагностики ПДО ФГБОУ ВО “Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого” Минздрава России, Красноярск БУЗ ОО “Городская клиническая больница скорой медицинской помощи №1”, ОмскРоссияN.N. Petrov National Medical Research Center of OncologyRussian FederationФГБУ “Национальный медицинский исследовательский центр онкологии им. Н.Н. Петрова”РоссияKrasnoyarsk state medical university named after Prof. V.F. Voyno-Yasenetsky Omsk City Emergency Hospital №1Russian Federation201828102018054554Copyright © Косичкина А.Б., Мищенко А.В., Кулева С.А., Доровских Г.Н., Буровик И.А., Артемьева А.С., Петрова А.С., Гарибян С.А., Бойко Н.В., Козырева К.С., Калинин П.С., 20182018Косичкина А.Б., Мищенко А.В., Кулева С.А., Доровских Г.Н., Буровик И.А., Артемьева А.С., Петрова А.С., Гарибян С.А., Бойко Н.В., Козырева К.С., Калинин П.С.Kosichkina A.B., Mishchenko A.V., Kuleva S.A., Burovik I.A., Artemeva A.S., Petrova A.S., Gharibyan S.A., Boiko N.V., Kozyreva K.S., Kalinin P.S., Dorovskikh G.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/654

Мукормикоз легких – редко встречающаяся оппортунистическая инфекция, вызванная грибами, которые относятся к порядку Mucorales класса Zygomycetes. Основными факторами риска развития заболеванияявляются сахарный диабет и глубокая нейтропения. В последние годы отмечается рост частоты встречаемости мукормикоза, что связывают с более широким применением агрессивных схем химиотерапии, в том числе возрастным пациентам, а также увеличением числа трансплантаций стволовых клеток крови. Заболевание характеризуется тяжелым течением с быстрой генерализацией и высокой летальностью. Применение лучевых методов диагностики – первый способ обследования пациента при подозрении на инфекционный процесс. Выявление характерных признаков мукормикоза позволяет лечащему врачу назначать дальнейшие исследования и поставить ранний диагноз, что в свою очередь значительно улучшает прогноз заболевания.

Pulmonary mucormycosis is a rare opportunistic fungal infection, caused by Zygomycetes, order Mucorales. Poorly controlled diabetes mellitus and neutropenia are main risk factors. In recent years, the incidence of mucormycosis is increasing, due to widespread use of aggressive chemotherapy, including schemes for elder patients and increasing amount of stem cell transplantation. The disease is characterised by severe course, rapid spread and high mortality rates. Radiological diagnostics is first line methods in detecting infectious process in patients. Detecting specific features helps physician in early diagnosis and improve outcome of disease.

мукормикоззигомикозмикозинфекционные осложненияпневмонияиммуноком- прометированные пациентыпациенты с нейтропениейкомпьютерная томографияmucormycosiszygomycosismycosisinfectious complicationspneumoniaimmunocompromised patientspatients with neutropeniacomputed tomographyReferencesАравийский Р.А., Климко Н.Н., Васильева Н.В. Диагностика микозов. СПб.: СПбМАПО, 2004. 185 с.Araviyskiy R.A., Klimko N.N., Vasileva N.V. Diagnostics of Mycosis. SPb.: SPbMAPO, 2004. 185 p. (In Russian)Ribes J.A., Vanover-Sams C.L., Baker D.J. Zygomycetes in human disease. Clin. Microbiol. Rev. 2000; 13: 236–301.Ribes J.A., Vanover-Sams C.L., Baker D.J. Zygomycetes in human disease. Clin. Microbiol. Rev. 2000; 13: 236–301.Хостелиди С.Н. Главное о зигомикозе (обзор). Проблемы медицинской микологии. 2006; 8 (4): 8–18.Khostelidi S.N. The Principal About Zygomycosis (Review). Problems of medical mycology. 2006; 8 (4): 8–18. (In Russian)Thajeb P., Thajeb T., Dai D. Fatal strokes in patients with rhino-orbito-cerebral mucormycosis and associated vasculopathy. Scand. J. Infect. Dis. 2004; 36: 643–648.Thajeb P., Thajeb T., Dai D. Fatal strokes in patients with rhino-orbito-cerebral mucormycosis and associated vasculopathy. Scand. J. Infect. Dis. 2004; 36: 643–648.Goodman & Rinaldi 1991, http://www.rusmedserv.com/mycology/index.htmlGoodman & Rinaldi 1991, http://www.rusmedserv.com/mycology/index.htmlHibbett D.S., Binder M., Bischoff J.F., Blackwell M., Cannon P.F., Eriksson O.E., Huhndorf S., James T., Kirk P.M., Lücking R., Thorsten Lumbsch H., Lutzoni F., Matheny P.B., McLaughlin D.J., Powell M.J., Redhead S., Schoch C.L., Spatafora J.W., Stalpers J.A., Vilgalys R., Aime M.C., Aptroot A., Bauer R., Begerow D., Benny G.L., Castlebury L.A., Crous P.W., Dai Y.C., Gams W., Geiser D.M., Griffith G.W., Gueidan C., Hawksworth D.L., Hestmark G., Hosaka K., Humber R.A., Hyde K.D., Ironside J.E., Kõljalg U., Kurtzman C.P., Larsson K.H., Lichtwardt R., Longcore J., Miadlikowska J., Miller A., Moncalvo J.M., Mozley-Standridge S., Oberwinkler F., Parmasto E., Reeb V., Rogers J.D., Roux C., Ryvarden L., Sampaio J.P., Schüssler A., Sugiyama J., Thorn R.G., Tibell L., Untereiner W.A., Walker C., Wang Z., Weir A., Weiss M., White M.M., Winka K., Yao Y.J., Zhang N. A higher-level phylogenetic classification of the Fungi. Mycological Res. 2007; 111 (5): 509–547. DOI: 10.1016/j.mycres.2007.03.004.Hibbett D.S., Binder M., Bischoff J.F., Blackwell M., Cannon P.F., Eriksson O.E., Huhndorf S., James T., Kirk P.M., Lücking R., Thorsten Lumbsch H., Lutzoni F., Matheny P.B., McLaughlin D.J., Powell M.J., Redhead S., Schoch C.L., Spatafora J.W., Stalpers J.A., Vilgalys R., Aime M.C., Aptroot A., Bauer R., Begerow D., Benny G.L., Castlebury L.A., Crous P.W., Dai Y.C., Gams W., Geiser D.M., Griffith G.W., Gueidan C., Hawksworth D.L., Hestmark G., Hosaka K., Humber R.A., Hyde K.D., Ironside J.E., Kõljalg U., Kurtzman C.P., Larsson K.H., Lichtwardt R., Longcore J., Miadlikowska J., Miller A., Moncalvo J.M., Mozley-Standridge S., Oberwinkler F., Parmasto E., Reeb V., Rogers J.D., Roux C., Ryvarden L., Sampaio J.P., Schüssler A., Sugiyama J., Thorn R.G., Tibell L., Untereiner W.A., Walker C., Wang Z., Weir A., Weiss M., White M.M., Winka K., Yao Y.J., Zhang N. A higher-level phylogenetic classification of the Fungi. Mycological Res. 2007; 111 (5): 509–547. DOI: 10.1016/j.mycres.2007.03.004.Petrikkos G., Skiada A., Lortholary O., Roilides E., Walsh T.J., Kontoyiannis D.P.. Epidemiology and clinical manifestations of mucormycosis. Clin. Infect. Dis. 2012; 54, Suppl 1: S23–S34. DOI: 10.1093/cid/cir866.Petrikkos G., Skiada A., Lortholary O., Roilides E., Walsh T.J., Kontoyiannis D.P.. Epidemiology and clinical manifestations of mucormycosis. Clin. Infect. Dis. 2012; 54, Suppl 1: S23–S34. DOI: 10.1093/cid/cir866.Bourcier J., Heudes P.M., Morio F., Gastinne T., Chevallier P., Rialland-Battisti F., Garandeau C., Danner-Boucher I., Le Pape P., Frampas E., Moreau P., Defrance C., Peterlin P. Prevalence of the reversed halo sign in neutropenic patients compared with non- neutropenic patients: Data from a single – centre study involving 27 patients with pulmonary mucormycosis (2003–2016). Mycoses. 2017; 60 (8): 526–533. DOI: 10.1111/myc.12624.Bourcier J., Heudes P.M., Morio F., Gastinne T., Chevallier P., Rialland-Battisti F., Garandeau C., Danner-Boucher I., Le Pape P., Frampas E., Moreau P., Defrance C., Peterlin P. Prevalence of the reversed halo sign in neutropenic patients compared with non- neutropenic patients: Data from a single – centre study involving 27 patients with pulmonary mucormycosis (2003–2016). Mycoses. 2017; 60 (8): 526–533. DOI: 10.1111/myc.12624.Spellberg B., Ibrahim A. S. Recent advances in the treatment of mucormycosis. Curr. Infect. Dis. Rep. 2010; 12 (6): 423–429. DOI: 10.1007/s11908-010-0129-9.Spellberg B., Ibrahim A. S. Recent advances in the treatment of mucormycosis. Curr. Infect. Dis. Rep. 2010; 12 (6): 423–429. DOI: 10.1007/s11908-010-0129-9.Roden M.M., Zaoutis T.E., Buchanan W.L., Knudsen T.A., Sarkisova T.A., Schaufele R.L., Sein M., Sein T., Chiou C.C., Chu J.H., Kontoyiannis D.P., Walsh T.J. Epidemiology and Outcome of Zygomycosis: a review of 929 reported cases. Clin. Infect. Dis. 2005; 41: 634–653. DOI: 10.1086/432579.Roden M.M., Zaoutis T.E., Buchanan W.L., Knudsen T.A., Sarkisova T.A., Schaufele R.L., Sein M., Sein T., Chiou C.C., Chu J.H., Kontoyiannis D.P., Walsh T.J. Epidemiology and Outcome of Zygomycosis: a review of 929 reported cases. Clin. Infect. Dis. 2005; 41: 634–653. DOI: 10.1086/432579.Климко Н.Н. Микозы: диагностика и лечение. М.: Ви Джи Групп, 2008. 336 с.Klimko N.N. Mycoses: diagnosis and treatment. Moscow: Izdatel’stvo Vi Dzhi Grupp, 2008. 336 р. (In Russian)Lin E., Moua T., Limper A.H. Pulmonary mucormycosis: clinical features and outcomes. Infection. 2017; 45 (4): 443–448. DOI: 10.1007/s15010-017-0991-6.Lin E., Moua T., Limper A.H. Pulmonary mucormycosis: clinical features and outcomes. Infection. 2017; 45 (4): 443–448. DOI: 10.1007/s15010-017-0991-6.Gleissner B., Schilling A., Anagnostopolous I., Siehl I., Thiel E., Anagnostopolous I., et al. Improved outcome of zygomycosis in patients with hematological diseases? Leukemia Lymphoma. 2004; 45: 1351–1360.Gleissner B., Schilling A., Anagnostopolous I., Siehl I., Thiel E., Anagnostopolous I., et al. Improved outcome of zygomycosis in patients with hematological diseases? Leukemia Lymphoma. 2004; 45: 1351–1360.Caillot D., Valot S., Lafon I., Basmaciyan L., Chretien M.L., Sautour M., Million L., Legouge C., Payssot A., Dalle F. Is it time to include CT “Reverse Halo Sign” and qPCR targeting mucorales in serum to EORTC-MSG criteria for the diagnosis of pulmonary mucormycosis in leukemia patients? Open forum infectious diseases. Oxford University Press. 2016; 3 (4): fw190. DOI: 10.1093/ofid/ofw190.Caillot D., Valot S., Lafon I., Basmaciyan L., Chretien M.L., Sautour M., Million L., Legouge C., Payssot A., Dalle F. Is it time to include CT “Reverse Halo Sign” and qPCR targeting mucorales in serum to EORTC-MSG criteria for the diagnosis of pulmonary mucormycosis in leukemia patients? Open forum infectious diseases. Oxford University Press. 2016; 3 (4): fw190. DOI: 10.1093/ofid/ofw190.Millon L., Herbrecht R., Grenouillet F., Morio F., Alanio A., Letscher-Bru V., Cassaing S., Chouaki T., Kauffmann-Lacroix C., Poirier P., Toubas D., Augereau O., Rocchi S., Garcia-Hermoso D., Bretagne S.; French Mycosis Study Group. Early diagnosis and monitoring of mucormycosis by detection of circulating DNA in serum: retrospective analysis of 44 cases collected through the French Surveillance Network of Invasive Fungal Infections (RESSIF). Clin. Microbiol. Infect. 2016; 22: 810. e1–810. e8. DOI: 10.1016/j.cmi.2015.12.006.Millon L., Herbrecht R., Grenouillet F., Morio F., Alanio A., Letscher-Bru V., Cassaing S., Chouaki T., Kauffmann-Lacroix C., Poirier P., Toubas D., Augereau O., Rocchi S., Garcia-Hermoso D., Bretagne S.; French Mycosis Study Group. Early diagnosis and monitoring of mucormycosis by detection of circulating DNA in serum: retrospective analysis of 44 cases collected through the French Surveillance Network of Invasive Fungal Infections (RESSIF). Clin. Microbiol. Infect. 2016; 22: 810. e1–810. e8. DOI: 10.1016/j.cmi.2015.12.006.Millon L., Larosa F., Lepiller Q., Legrand F., Rocchi S., Daguindau E., Scherer E., Bellanger A.P., Leroy J., Grenouillet F. Quantitative polymerase chain reaction detec tion of circulating DNA in serum for early diagnosis of mucormycosis in immunocompromised patients. Clin. Infect. Dis. 2013; 56 (10): e95–e101. DOI: 10.1093/cid/cit094.Millon L., Larosa F., Lepiller Q., Legrand F., Rocchi S., Daguindau E., Scherer E., Bellanger A.P., Leroy J., Grenouillet F. Quantitative polymerase chain reaction detec tion of circulating DNA in serum for early diagnosis of mucormycosis in immunocompromised patients. Clin. Infect. Dis. 2013; 56 (10): e95–e101. DOI: 10.1093/cid/cit094.De Pauw B., Walsh T.J., Donnelly J.P., Stevens D.A., Edwards J.E., Calandra T., Pappas P.G., Maertens J., Lortho lary O., Kauffman C.A., Denning D.W., Patterson T.F., Maschmeyer G., Bille J., Dismukes W.E., Herbrecht R., Hope W.W., Kibbler C.C., Kullberg B.J., Marr K.A., Muñoz P., Odds F.C., Perfect J.R., Restrepo A., Ruhnke M., Segal B.H., Sobel J.D., Sorrell T.C., Viscoli C., Wingard J.R., Zaoutis T., Bennett J.E.; European Organization for Research and Treatment of Cancer/Invasive Fungal-Infections Cooperative Group; National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Revised definitions of invasive fungal disease from the European organization for research and treatment of cancer/invasive fungal infections cooperative group and the national institute of allergy and infectious diseases mycoses study group (EORTC/MSG) consensus group. Clin. Infect. Dis. 2008; 46 (12): 1813–1821. DOI: 10.1086/588660.De Pauw B., Walsh T.J., Donnelly J.P., Stevens D.A., Edwards J.E., Calandra T., Pappas P.G., Maertens J., Lortho lary O., Kauffman C.A., Denning D.W., Patterson T.F., Maschmeyer G., Bille J., Dismukes W.E., Herbrecht R., Hope W.W., Kibbler C.C., Kullberg B.J., Marr K.A., Muñoz P., Odds F.C., Perfect J.R., Restrepo A., Ruhnke M., Segal B.H., Sobel J.D., Sorrell T.C., Viscoli C., Wingard J.R., Zaoutis T., Bennett J.E.; European Organization for Research and Treatment of Cancer/Invasive Fungal-Infections Cooperative Group; National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Revised definitions of invasive fungal disease from the European organization for research and treatment of cancer/invasive fungal infections cooperative group and the national institute of allergy and infectious diseases mycoses study group (EORTC/MSG) consensus group. Clin. Infect. Dis. 2008; 46 (12): 1813–1821. DOI: 10.1086/588660.Cornely O.A., Arikan-Akdagli S., Dannaoui E., Groll A.H., Lagrou K., Chakrabarti A., Lanternier F., Pagano L., Skiada A., Akova M., Arendrup M.C., Boekhout T., Chowdhary A., Cuenca-Estrella M., Freiberger T., Guinea J., Guarro J., de Hoog S., Hope W., Johnson E., Kathuria S., Lackner M., Lass-Flörl C., Lortholary O., Meis J.F., Meletiadis J., Muñoz P., Richardson M., Roilides E., Tortorano A.M., Ullmann A.J., van Diepeningen A., Verweij P., Petrikkos G.; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group; European Confederation of Medical Mycology. ESCMID† and ECMM‡ joint clinical guidelines for the diagnosis and management of mucormycosis. 2013; Clin. Microbiol. Infect. 2014; 20: 5–26. DOI: 10.1111/1469-0691.12371.Cornely O.A., Arikan-Akdagli S., Dannaoui E., Groll A.H., Lagrou K., Chakrabarti A., Lanternier F., Pagano L., Skiada A., Akova M., Arendrup M.C., Boekhout T., Chowdhary A., Cuenca-Estrella M., Freiberger T., Guinea J., Guarro J., de Hoog S., Hope W., Johnson E., Kathuria S., Lackner M., Lass-Flörl C., Lortholary O., Meis J.F., Meletiadis J., Muñoz P., Richardson M., Roilides E., Tortorano A.M., Ullmann A.J., van Diepeningen A., Verweij P., Petrikkos G.; European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group; European Confederation of Medical Mycology. ESCMID† and ECMM‡ joint clinical guidelines for the diagnosis and management of mucormycosis. 2013; Clin. Microbiol. Infect. 2014; 20: 5–26. DOI: 10.1111/1469-0691.12371.Chamilos G., Lewis R.E., Kontoyiannis D.P. Delaying amphotericin B–based frontline therapy significantly increases mortality among patients with gematologic malignancy who have zygomycosis. Clin. Infect. Dis. 2008; 47 (4): 503–509. DOI: 10.1086/590004.Chamilos G., Lewis R.E., Kontoyiannis D.P. Delaying amphotericin B–based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin. Infect. Dis. 2008; 47 (4): 503–509. DOI: 10.1086/590004.Cereser L., Zuiani C., Graziani G., Girometti R., Como G., Zaja F., Bazzocchi M. Impact of clinical data on chest radiography sensitivity in detecting pulmonary abnormalities in immunocompromised patients with suspected pneumonia. La Radiologia Medica. 2010; 115 (2): 205–214. DOI: 10.1007/s11547-009-0433-3.Cereser L., Zuiani C., Graziani G., Girometti R., Como G., Zaja F., Bazzocchi M. Impact of clinical data on chest radiography sensitivity in detecting pulmonary abnormalities in immunocompromised patients with suspected pneumonia. La Radiologia Medica. 2010; 115 (2): 205–214. DOI: 10.1007/s11547-009-0433-3.Roy V., Ali L.I., Selby G.B. Routine chest radiography for the evaluation of febrile neutropenic patients after autologous stem cell transplantation. Am. J. Hematol. 2000; 64 (3): 170–174.Roy V., Ali L.I., Selby G.B. Routine chest radiography for the evaluation of febrile neutropenic patients after autologous stem cell transplantation. Am. J. Hematol. 2000; 64 (3): 170–174.McAdams H.P., Rosado de Christenson M., Strollo D.C., Patz E.F. Jr. Pulmonary mucormycosis: radiologic findings in 32 cases. Am. J. Roentgenol. 1997; 168 (6): 1541–1548.McAdams H.P., Rosado de Christenson M., Strollo D.C., Patz E.F. Jr. Pulmonary mucormycosis: radiologic findings in 32 cases. Am. J. Roentgenol. 1997; 168 (6): 1541–1548.Hatrick A. G., Matson M. B., Bingham J. B. Invasive pulmonary mucormycosis with vascular involvement. Grand. Rounds. 2001; 2: 8–10. DOI: 10.1102/1470-5206.2001.0013.Hatrick A. G., Matson M. B., Bingham J. B. Invasive pulmonary mucormycosis with vascular involvement. Grand. Rounds. 2001; 2: 8–10. DOI: 10.1102/1470-5206.2001.0013.Hammer M.M., Madan R., Hatabu H. Pulmonary Mucormycosis: Radiologic Features at Presentation and Over Time. Am. J. Roentgenol. 2018; 210 (4): 742–747. DOI: 10.2214/AJR.17.18792.Hammer M.M., Madan R., Hatabu H. Pulmonary Mucormycosis: Radiologic Features at Presentation and Over Time. Am. J. Roentgenol. 2018; 210 (4): 742–747. DOI: 10.2214/AJR.17.18792.Da Nam B., Kim T.J., Lee K.S., Kim T.S., Han J., Chung M.J. Pulmonary mucormycosis: serial morphologic changes on computed tomography correlate with clinical and pathologic findings. Eur. Radiol. 2018; 28 (2): 788–795. DOI: 10.1007/s00330-017-5007-5.Da Nam B., Kim T.J., Lee K.S., Kim T.S., Han J., Chung M.J. Pulmonary mucormycosis: serial morphologic changes on computed tomography correlate with clinical and pathologic findings. Eur. Radiol. 2018; 28 (2): 788–795. DOI: 10.1007/s00330-017-5007-5.Georgiadou S.P., , Sipsas N.V., Marom E.M., Kontoyiannis D.P. The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts. Clin. Infect. Dis. 2011; 52 (9): 1144–1155. DOI: 10.1093/cid/cir12.Georgiadou S.P., , Sipsas N.V., Marom E.M., Kontoyiannis D.P. The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts. Clin. Infect. Dis. 2011; 52 (9): 1144–1155. DOI: 10.1093/cid/cir12.Choo J.Y., Park C.M., Lee H.J., Lee C.H., Goo J.M., Im J.G. Sequential morphological changes in follow-up CT of pulmonary mucormycosis. Diagn. Intervent. Radiol. 2014; 20 (1): 42. DOI: 10.5152/dir.2013.13183.Choo J.Y., Park C.M., Lee H.J., Lee C.H., Goo J.M., Im J.G. Sequential morphological changes in follow-up CT of pulmonary mucormycosis. Diagn. Intervent. Radiol. 2014; 20 (1): 42. DOI: 10.5152/dir.2013.13183.Caillot D., Legouge C., Lafon I., Ferrant E., Pagès P.B., Plocque A., Estivalet L., Valot S., Dalle F., Abou Hanna H., Chretien M.L. Mucormycoses pulmonaires au cours des traitements de leucémies aiguës. Analyse rétrospective d’une série de 25 patients. Revue des Maladies Respiratoires. 2018. DOI: 10.1016/j.rmr.2017.11.009.Caillot D., Legouge C., Lafon I., Ferrant E., Pagès P.B., Plocque A., Estivalet L., Valot S., Dalle F., Abou Hanna H., Chretien M.L. Mucormycoses pulmonaires au cours des traitements de leucémies aiguës. Analyse rétrospective d’une série de 25 patients. Revue des Maladies Respiratoires. 2018. DOI: 10.1016/j.rmr.2017.11.009.Voloudaki A.E., Bouros D.E., Froudarakis M.E., Datseris G.E., Apostolaki E.G., Gourtsoyiannis N.C. Crescentic and ring- shaped opacities. CT features in two cases of bronchiolitis obliterans organizing pneumonia (BOOP). Acta Radiol. 1996; 37: 889–892.Voloudaki A.E., Bouros D.E., Froudarakis M.E., Datseris G.E., Apostolaki E.G., Gourtsoyiannis N.C. Crescentic and ring- shaped opacities. CT features in two cases of bronchiolitis obliterans organizing pneumonia (BOOP). Acta Radiol. 1996; 37: 889–892.Godoy M.C.B., Viswanathan C., Marchiori E., Truong M.T., Benveniste M.F., Rossi S., Marom E.M. The reversed halo sign: update and differential diagnosis. Br. J. Radiol. 2012; 85: 1226–1235. DOI: 10.1259/bjr/54532316.Godoy M.C.B., Viswanathan C., Marchiori E., Truong M.T., Benveniste M.F., Rossi S., Marom E.M. The reversed halo sign: update and differential diagnosis. Br. J. Radiol. 2012; 85: 1226–1235. DOI: 10.1259/bjr/54532316.Rea G., Dalpiaz G., Vatrella A., Damiani S., Marchiori E. The reversed halo sign: also think about chronic eosinophilic pneumonia. J. Brasileiro de Pneumologia. 2017; 43 (4): 322–323. DOI: 10.1590/S1806-7562017000000077.Rea G., Dalpiaz G., Vatrella A., Damiani S., Marchiori E. The reversed halo sign: also think about chronic eosinophilic pneumonia. J. Brasileiro de Pneumologia. 2017; 43 (4): 322–323. DOI: 10.1590/S1806-37562017000000077.Marchiori E., Marom E.M., Zanetti G., Hochhegger B., Irion K.L., Godoy M.C.B. Reversed halo sign in invasive fungal infections: criteria for differentiation from organizing pneumonia. Chest J. 2012; 142: 1469. DOI: 10.1378/chest.12-0114.Marchiori E., Marom E.M., Zanetti G., Hochhegger B., Irion K.L., Godoy M.C.B. Reversed halo sign in invasive fungal infections: criteria for differentiation from organizing pneumonia. Chest J. 2012; 142: 1469. DOI: 10.1378/chest.12-0114.Marchiori E., Hochhegger B., Zanetti G. Reversed halo sign in invasive fungal infections. Jornal Brasileiro de Pneumologia. 2016; 42 (3): 232–232. DOI: 10.1590/S1806-37562016000000119.Marchiori E., Hochhegger B., Zanetti G. Reversed halo sign in invasive fungal infections. Jornal Brasileiro de Pneumologia. 2016; 42 (3): 232–232. DOI: 10.1590/S1806-37562016000000119.Marchiori E., Menna Barreto M., Pereira Freitas H.M., Hochhegger B., Soares Souza A Jr., Zanetti G., Dias Mançano A., Souza Rodrigues R. Morphological characteristics of the reversed halo sign that may strongly suggest pulmonary infarction. Clin. Radiol. 2018; 73 (5): 503. e7–503. e13. DOI: 10.1016/j.crad.2017.11.022.Marchiori E., Menna Barreto M., Pereira Freitas H.M., Hochhegger B., Soares Souza A Jr., Zanetti G., Dias Mançano A., Souza Rodrigues R. Morphological characteristics of the reversed halo sign that may strongly suggest pulmonary infarction. Clin. Radiol. 2018; 73 (5): 503. e7–503. e13. DOI: 10.1016/j.crad.2017.11.022.Wahba H., Truong M.T., Lei X., Kontoyiannis D.P., Marom E.M. Reversed halo sign in invasive pulmonary fungal infections. Clin. Infect. Dis. 2008; 46: 1733–1737. DOI: 10.1086/587991.v.Wahba H., Truong M.T., Lei X., Kontoyiannis D.P., Marom E.M. Reversed halo sign in invasive pulmonary fungal infections. Clin. Infect. Dis. 2008; 46: 1733–1737. DOI: 10.1086/587991.v.Jung J., Kim M.Y., Lee H.J., Park Y.S., Lee S.O., Choi S.H., Kim Y.S., Woo J.H., Kim S.H. Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis. Clin. Microbiol. Infect. 2015; 21 (7): 684. e11–684. e18. DOI: 10.1016/j.cmi.2015.03.019.Jung J., Kim M.Y., Lee H.J., Park Y.S., Lee S.O., Choi S.H., Kim Y.S., Woo J.H., Kim S.H. Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis. Clin. Microbiol. Infect. 2015; 21 (7): 684. e11–684. e18. DOI: 10.1016/j.cmi.2015.03.019.Legouge C., Caillot D., Chrétien M.L., Lafon I., Ferrant E., Audia S., Pagès P.B., Roques M., Estivalet L., Martin L., Maitre T., Bastie J.N., Dalle F. The reversed halo sign: pathognomonic pattern of pulmonary mucormycosis in leukemic patients with neutropenia? Clin. Infect. Dis. 2013; 58 (5): 672–678. DOI: 10.1093/cid/cit929.Legouge C., Caillot D., Chrétien M.L., Lafon I., Ferrant E., Audia S., Pagès P.B., Roques M., Estivalet L., Martin L., Maitre T., Bastie J.N., Dalle F. The reversed halo sign: pathognomonic pattern of pulmonary mucormycosis in leukemic patients with neutropenia? Clin. Infect. Dis. 2013; 58 (5): 672–678. DOI: 10.1093/cid/cit929.

The authors declare that there are no conflicts of interest present.