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Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the “black fungus”

A subset of diabetic COVID-19 patients treated with steroids, oxygen, and/or prolonged intensive care admission develop rhino-orbito-cerebral mucormycosis. Radiologists must have a high index of suspicion for early diagnosis, which prompts immediate institution of antifungal therapy that limits morb...

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Detalles Bibliográficos
Autores principales: Sanghvi, D., Kale, H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Royal College of Radiologists. Published by Elsevier Ltd. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316064/
https://www.ncbi.nlm.nih.gov/pubmed/34364672
http://dx.doi.org/10.1016/j.crad.2021.07.004
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author Sanghvi, D.
Kale, H.
author_facet Sanghvi, D.
Kale, H.
author_sort Sanghvi, D.
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description A subset of diabetic COVID-19 patients treated with steroids, oxygen, and/or prolonged intensive care admission develop rhino-orbito-cerebral mucormycosis. Radiologists must have a high index of suspicion for early diagnosis, which prompts immediate institution of antifungal therapy that limits morbidity and mortality. Assessment of disease extent by imaging is crucial for planning surgical debridement. Complete debridement of necrotic tissue improves survival. Imaging features reflect the angioinvasive behaviour of fungal hyphae from the Mucoraceae family, which cause necrotising vasculitis and thrombosis resulting in extensive tissue infarction. Contrast-enhanced magnetic resonance imaging (MRI) is the imaging technique of choice. The classic “black turbinate” on contrast-enhanced imaging represents localised invasive fungal rhinosinusitis (IFRS). A striking radiological feature of disseminated craniofacial disease is non-enhancing devitalised and necrotic soft tissue at the orbits and central skull base. Sinonasal and extrasinonasal non-enhancing lesions in IFRS are secondary to coagulative necrosis induced by fungal elements. Multicompartmental and extrasinonasal tissue infarction is possible without overt bone involvement and caused by the propensity of fungal elements to disseminate from the nasal cavity via perineural and perivascular routes. Fungal vasculitis can result in internal carotid artery occlusion and cerebral infarction. Remnant non-enhancing lesions after surgical debridement portend a poor prognosis. Assessment for the non-enhancing MRI lesion is crucial, as it is a sole independent prognostic factor for IFRS-specific mortality. In this review, we describe common and uncommon imaging presentations of biopsy-proven rhino-orbito-cerebral mucormycosis in a cohort of nearly 40 COVID-19 patients.
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spelling pubmed-83160642021-07-28 Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the “black fungus” Sanghvi, D. Kale, H. Clin Radiol Pictorial Review A subset of diabetic COVID-19 patients treated with steroids, oxygen, and/or prolonged intensive care admission develop rhino-orbito-cerebral mucormycosis. Radiologists must have a high index of suspicion for early diagnosis, which prompts immediate institution of antifungal therapy that limits morbidity and mortality. Assessment of disease extent by imaging is crucial for planning surgical debridement. Complete debridement of necrotic tissue improves survival. Imaging features reflect the angioinvasive behaviour of fungal hyphae from the Mucoraceae family, which cause necrotising vasculitis and thrombosis resulting in extensive tissue infarction. Contrast-enhanced magnetic resonance imaging (MRI) is the imaging technique of choice. The classic “black turbinate” on contrast-enhanced imaging represents localised invasive fungal rhinosinusitis (IFRS). A striking radiological feature of disseminated craniofacial disease is non-enhancing devitalised and necrotic soft tissue at the orbits and central skull base. Sinonasal and extrasinonasal non-enhancing lesions in IFRS are secondary to coagulative necrosis induced by fungal elements. Multicompartmental and extrasinonasal tissue infarction is possible without overt bone involvement and caused by the propensity of fungal elements to disseminate from the nasal cavity via perineural and perivascular routes. Fungal vasculitis can result in internal carotid artery occlusion and cerebral infarction. Remnant non-enhancing lesions after surgical debridement portend a poor prognosis. Assessment for the non-enhancing MRI lesion is crucial, as it is a sole independent prognostic factor for IFRS-specific mortality. In this review, we describe common and uncommon imaging presentations of biopsy-proven rhino-orbito-cerebral mucormycosis in a cohort of nearly 40 COVID-19 patients. The Royal College of Radiologists. Published by Elsevier Ltd. 2021-11 2021-07-28 /pmc/articles/PMC8316064/ /pubmed/34364672 http://dx.doi.org/10.1016/j.crad.2021.07.004 Text en © 2021 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Pictorial Review
Sanghvi, D.
Kale, H.
Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the “black fungus”
title Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the “black fungus”
title_full Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the “black fungus”
title_fullStr Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the “black fungus”
title_full_unstemmed Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the “black fungus”
title_short Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the “black fungus”
title_sort imaging of covid-19-associated craniofacial mucormycosis: a black and white review of the “black fungus”
topic Pictorial Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316064/
https://www.ncbi.nlm.nih.gov/pubmed/34364672
http://dx.doi.org/10.1016/j.crad.2021.07.004
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