H/O CHEST PAIN, SEVERE BREATHLESSNESS, DRY COUGH, FEVER SINCE 20 DAYS
- H/O CHEST PAIN, SEVERE BREATHLESSNESS, DRY COUGH, FEVER SINCE 20 DAYS.
- Axial CT Chest lung window showing areas of collapse consolidation with peripheral ground glass opacity with interstitial thickening (yellow and blue arrows) in the bilateral lungs with areas of break down and central cavitation.
- Axial CT Chest Mediastinal window showing loculated bilateral pleural effusion(orange arrows).
- Coronal CT Chest lung window showing peripheral ground glass opacity (black arrow).
- Sagittal CT Chest lung window showing internal septations in the cavitation
DIAGNOSIS:
- Invasive aspergillosis- Bird nest sign.
DISCUSSION:
- The bird’s nest sign refers to the appearance created by a reverse halo sign with associated irregular and intersecting areas of stranding or irregular lines within the area of ground-glass opacity .
- Both bird's nest sign and reverse halo signs are suggestive of invasive pulmonary fungal infection (e.g., angioinvasive aspergillus or mucormycosis) in susceptible patient populations.
DIFFERENTIAL DIAGNOSIS:
- cryptogenic organizing pneumonia
- bacterial pneumonia
- Tuberculosis
- sarcoidosis
- Wegener granulomatosis
REFRENCES:
- Christopher M. Walker, Gerald F. Abbott, Reginald E. Greene, Jo-Anne O. Shepard, Dharshan Vummidi, Subba R. Digumarthy. Imaging Pulmonary Infection: Classic Signs and Patterns. (2014) American Journal of Roentgenology. doi:10.2214/AJR.13.11463
- Jonathan H. Chung, J. David Godwin, Jason W. Chien, Sudhakar J. Pipavath. Case 160: Pulmonary Mucormycosis1. (2010) Radiology. doi:10.1148/radiol.10081907
- Chamilos, Georgios, Marom, Edith M., Lewis, Russell E., Lionakis, Michail S., Kontoyiannis, Dimitrios P.. Predictors of Pulmonary Zygomycosis versus Invasive Pulmonary Aspergillosis in Patients with Cancer. (2005) Clinical Infectious Diseases. 41 (1): 60. doi:10.1086/430710
- 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?. (2014) Clinical Infectious Diseases. 58 (5): 672. doi:10.1093/cid/cit929
Dr. Praween P wali
Senior Consultant Radiologist
Manipal Hospital, Yeshwanthpur, Bengaluru.
Dr. Nanda Gopal J
Cross sectional fellow
Manipal Hospital, Yeshwanthpur, Bengaluru.