Answer for BIR CoW 11 Jul 2021
Gastrointestinal mucormycosis
Findings
CT Abdomen - Inflammatory changes in the caecum & appendix with intramural air, surrounding fat stranding & few extraluminal air pockets. CT Chest – Patchy ground glass opacities in the bilateral lower lobes predominantly in the subpleural location – Atypical pneumonia (COVID positive). Patient underwent bowel resection & anastomosis, HPE - Invasive mucormycosis with bowel gangrene.
Discussion
Mucormycosis is most commonly seen in patients with an impaired immune system due to any cause. Gastrointestinal mucormycosis is the least frequent type and may be a primary disease or a feature of generalized mucormycosis. Angioinvasion is the hallmark feature of mucormycosis, leading to bowel infarction which is the responsible for the most common clinical complaint of pain, and is also responsible for most of the imaging findings in this disease. The stomach is most commonly involved organ in the gastrointestinal tract and pneumatosis and lack of gastric wall enhancement are the most common imaging findings. Areas of bowel wall thickening and/ or lack of enhancement are seen in small bowel mucor and perforation can occur due to ischemia. Colonic mucor can present with mural thickening, or complete lack of definition or 'disappearance' of bowel wall with associated air containing collections.
Findings
CT Abdomen - Inflammatory changes in the caecum & appendix with intramural air, surrounding fat stranding & few extraluminal air pockets. CT Chest – Patchy ground glass opacities in the bilateral lower lobes predominantly in the subpleural location – Atypical pneumonia (COVID positive). Patient underwent bowel resection & anastomosis, HPE - Invasive mucormycosis with bowel gangrene.
Discussion
Mucormycosis is most commonly seen in patients with an impaired immune system due to any cause. Gastrointestinal mucormycosis is the least frequent type and may be a primary disease or a feature of generalized mucormycosis. Angioinvasion is the hallmark feature of mucormycosis, leading to bowel infarction which is the responsible for the most common clinical complaint of pain, and is also responsible for most of the imaging findings in this disease. The stomach is most commonly involved organ in the gastrointestinal tract and pneumatosis and lack of gastric wall enhancement are the most common imaging findings. Areas of bowel wall thickening and/ or lack of enhancement are seen in small bowel mucor and perforation can occur due to ischemia. Colonic mucor can present with mural thickening, or complete lack of definition or 'disappearance' of bowel wall with associated air containing collections.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!