Imaging spectrum of mucormycosis in COVID-19 patients using computed tomography and magnetic resonance imaging

Abstract

Introduction: COVID-19 is an ongoing pandemic caused by severe acute respiratory syndrome coronavirus 2. Imaging plays an essential role in the diagnosis and management of symptomatic patients. Mucormycosis has gained popularity recently as a complication in COVID-19-affected patients. Various types of mucormycosis are rhino-orbito-cerebral, pulmonary, gastrointestinal, cutaneous, disseminated, and uncommon forms. Aim and Objective: We aimed to evaluate various radiological features of different types of mucormycosis infection in COVID-19 patients. Materials and Methods: We studied thirty COVID-19 patients retrospectively who were referred to our hospital over a period of 6 months (January to June 2021). Computed tomography (CT) and magnetic resonance imaging (MRI) were used for imaging evaluation of the patients. Imaging diagnosis was confirmed on histopathology in 21 patients. Results: We identified thirty cases of mucormycosis in COVID-19 patients in our tertiary center. Out of total cases, 18 were of pulmonary form, 9 of rhino-orbital form, and 3 of rhinocerebral form. Bird's nest pattern of cavitation was the most common feature in pulmonary form of mucormycosis. Acute unilateral rhinosinusitis with the presence of T2 hypointensities within periantral and intraorbital fat stranding was found to be the most specific imaging appearance in rhino-orbital form of mucormycosis. Rhinocerebral form showed contiguous spread of the disease from the sinuses to the meninges and brain parenchyma. Conclusion: Imaging plays a decisive role for early identification of the mucormycosis infection in COVID-19 patients and determination of the disease extent. CT and MRI help in accurate diagnosis of the disease and follow-up in postoperative patients.

Keywords

• bird's nest sign
• mucormycosis
• reversed halo sign