Title: CT Findings of COVID-19–associated Pulmonary Mucormycosis: A Case Series and Literature Review
Abstract: HomeRadiologyVol. 302, No. 1 PreviousNext Original ResearchFree AccessThoracic ImagingCT Findings of COVID-19–associated Pulmonary Mucormycosis: A Case Series and Literature ReviewMandeep Garg* , Nidhi Prabhakar*, Valliappan Muthu, Shameema Farookh, Harsimran Kaur, Vikas Suri, Ritesh AgarwalMandeep Garg* , Nidhi Prabhakar*, Valliappan Muthu, Shameema Farookh, Harsimran Kaur, Vikas Suri, Ritesh AgarwalAuthor AffiliationsFrom the Departments of Radiodiagnosis and Imaging (M.G., N.P., S.F.), Pulmonary Medicine (V.M., R.A.), Medical Microbiology (H.K.), and Internal Medicine (V.S.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.Address correspondence to M.G. (e-mail: [email protected]).Mandeep Garg* Nidhi Prabhakar*Valliappan MuthuShameema FarookhHarsimran KaurVikas SuriRitesh AgarwalPublished Online:Aug 31 2021https://doi.org/10.1148/radiol.2021211583MoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In * M.G. and N.P. contributed equally to this work.AbstractDownload as PowerPointIntroductionThere has been an unprecedented spike in COVID-19–associated mucormycosis (CAM), with most patients showing rhino-orbital involvement, whereas limited data are available on COVID-19–associated pulmonary mucormycosis (CAPM). Pulmonary mucormycosis is rare and has a high mortality rate (1). COVID-19 pneumonia makes it further challenging to identify pulmonary mucormycosis at radiologic imaging. Herein, we describe the imaging findings of three confirmed cases of CAPM and supplement it with a systematic review of the literature.Materials and MethodsIn this retrospective study (approved by the institute ethics committee), we describe the imaging and clinical features of three microbiologically confirmed cases of CAPM. We performed a systematic review of the PubMed and Embase databases, using the search terms ("COVID" OR "SARS-CoV" OR "coronavirus") AND (mucor* OR "zygomycosis") until June 14th, 2021, to identify published cases of CAPM (diagnosed as per current recommendations) (2). We included them for analysis if individual patient and imaging data were provided.ResultsAt our center, we diagnosed three cases of CAPM (Figure). Two of the three patients had no risk factor other than COVID-19. One case was of a man with diabetes with both rhino-orbital involvement and pulmonary mucormycosis. Two patients survived. We identified 180 cases of CAM in the literature during the review period and included only those 88 cases (14 CAPM and 74 nonpulmonary CAM) for which individual patient details were available (3–28). Of the 14 CAPM cases reported (three from the United States, two from the United Kingdom, three from the Netherlands, two from India, and one each from Italy, Austria, Chile, and France) (12,29–38), CT details were unavailable in one (12). After exclusions, we report the CT features of these 13 cases along with the three index cases reported by us (n = 16) (Table).Patient 1: A 45-year-old diabetic man, positive for SARS-CoV-2, presented with loss of vision in left eye and facial swelling on the 12th day of illness. (A) Coronal CT section of paranasal sinuses and orbits shows soft tissue in the left maxillary sinus (asterisk) causing blockage of osteomeatal complex. There is fat stranding in left orbit with increased bulk of left medial and inferior rectus muscles (arrows) suggesting orbital extension. (B) Axial CT chest sections show thick-walled cavitatory lesion in right lower lobe (black arrow) and large area of consolidation in left upper lobe (white arrow). Patchy ground-glass opacities (GGOs) with septal thickening were noted in bilateral lungs (dashed black arrow) consistent with underlying COVID-19 pneumonia. (C) Lactophenol cotton blue mount (10×) of culture of endotracheal aspirate depicted long smooth-walled sporangiophores, globose sporangia (black arrows), and subglobose to ellipsoidal sporangiospores with striations suggesting it to be Rhizopus arrhizus. Patient died 25 days after the onset of illness due to massive hemoptysis.Patient 2: A 36-year-old woman, positive for COVID-19 infection, had persistent hypoxia despite being on oxygen therapy and systemic corticosteroids. Chest CT was performed on day 24 of illness. (D,E) Axial sections of CT (lung window and corresponding mediastinal window) show multiple thin- to thick-walled cavities (black arrows in D; white arrows in E) in bilateral lungs, many of them showing air-fluid levels. Loculated right hydropneumothorax (⋆) with left pleural effusion was seen. (F) KOH wet mount preparation from endotracheal aspirate revealed aseptate, ribbon-like fungal hyphae (40×). Patient was started on amphotericin B and subsequently improved.Patient 3: A 45-year-man with no known comorbid illness, positive for SARS-CoV-2, underwent chest CT on day 25 of illness, due to persistent fever and dyspnea. (G) Coronal section of chest CT shows patchy GGOs and consolidation with septal thickening in right lung (curved arrows) consistent with underlying COVID-19 pneumonia. Note the mild right pneumothorax (dashed arrow). (H) Coronal CT chest section performed 7 days later shows cavitatory lesion in left lung with few septae within. Pneumothorax and COVID-19 pneumonia changes have resolved. (I) Direct microscopy (KOH mount) of endotracheal aspirate (40×) shows aseptate, ribbon-like broad hyphae. Patient improved on amphotericin B treatment and was discharged.Download as PowerPointClinical Characteristics, Imaging, Treatment, and Outcome of CAPM versus CAMThe most frequent CT findings were consolidation and cavitation seen in 11 (69%) patients. Pleural effusion was seen in seven (47%) patients, pneumothorax and nodules in three (19%) patients, and the "reverse halo" and pulmonary embolism were seen in two (13%) patients.We compared CAPM with nonpulmonary CAM identified from our review (Table). The risk factor profile was significantly different in both groups. No risk factors other than COVID-19 and its treatment were identified in 47% of CAPM. Although diabetes mellitus was common in CAPM (29%), it was significantly less than in nonpulmonary CAM (82%). Patients with CAPM were more often undergoing mechanical ventilation than were patients with nonpulmonary CAM (71% vs 40%; P = .02). CAPM was diagnosed after a median of 20 days (range, 9–29 days) after the onset of COVID-19 symptoms. Surgery was performed only in 12% of patients with CAPM, whereas 82% of patients with nonpulmonary CAM (mostly rhino-orbital) underwent surgery. Amphotericin-B was not instituted in 18% and 3% of the CAPM and nonpulmonary CAM cases, respectively (P = .02). CAPM had higher mortality than did nonpulmonary CAM cases (71% vs 42%; P = .03). Notably, three CAPM cases were not suspected antemortem (30,34,38).DiscussionMucormycosis has been shown to occur in fewer than 1% of hospitalized patients with COVID-19, and pulmonary mucormycosis accounts for 9% of CAM (39,40). Although CT findings of pulmonary mucormycosis have been described previously (41,42), CAPM has not been systematically explored. In a study reporting pulmonary mucormycosis among hematologic malignancies (before the COVID-19 pandemic), consolidation (55%), and nodules (35%) were the primary initial findings, whereas central necrosis, cavity, and air crescent sign appeared later (41). We found consolidation and cavitation to be the predominant findings (69%) in our study, possibly reflecting delayed identification of cases of CAPM. The imaging findings of CAPM may overlap with COVID-19–associated pulmonary aspergillosis and cavitating bacterial pneumonias, making the differentiation difficult. Sometimes even coinfections are seen (29,31).There were few limitations in our study. We included only confirmed cases of CAPM and it may not reflect the entire spectrum, because many patients with high suspicion remain unproven or die before reaching the hospital. Second, we did not evaluate serial CT findings. Third, many published reports did not explicitly catalog the CT findings of CAPM. We summarized the data from a small number of patients with CAPM, and larger studies are required.In conclusion, COVID-19–associated pulmonary mucormycosis (CAPM) has higher mortality than does nonpulmonary CAPM, and the most frequent CT findings of CAPM are consolidation and cavitation.Disclosures of conflicts of interest: M.G. No relevant relationships. N.P. No relevant relationships. V.M. No relevant relationships. S.F. No relevant relationships. H.K. No relevant relationships. V.S. No relevant relationships. R.A. No relevant relationships.AcknowledgmentsWe thank Dr MS Sandhu, MD; Dr GD Puri, MD; Dr Arunaloke Chakrabarty, MD; Dr Ashish Bhalla, MD; Dr Shivaprakash M. Rudramurthy, MD; Dr Mandeep Kang, MD; and Dr Inderpaul Sehgal, DM (PGIMER, Chandigarh, India) for their valuable opinions and input.Author ContributionsAuthor contributions: Guarantors of integrity of entire study, M.G., N.P., V.M., V.S.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, M.G., N.P., V.M., S.F., V.S.; clinical studies, M.G., N.P., V.M., H.K., V.S.; experimental studies, V.S.; statistical analysis, N.P., V.M., V.S.* M.G. and N.P. contributed equally to this work.Referencses1. Muthu V, Agarwal R, Dhooria S, et al. Has the mortality from pulmonary mucormycosis changed over time? A systematic review and meta-analysis. Clin Microbiol Infect 2021;27(4):538–549. MedlineGoogle Scholar2. Donnelly JP, Chen SC, Kauffman CA, et al. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis 2020;71(6):1367–1376. MedlineGoogle Scholar3. Ravani SA, Agrawal GA, Leuva PA, Modi PH, Amin KD. Rise of the phoenix: Mucormycosis in COVID-19 times. Indian J Ophthalmol 2021;69(6):1563–1568. MedlineGoogle Scholar4. Mekonnen ZK, Ashraf DC, Jankowski T, et al. Acute Invasive Rhino-Orbital Mucormycosis in a Patient With COVID-19-Associated Acute Respiratory Distress Syndrome. Ophthal Plast Reconstr Surg 2021;37(2):e40–e80. MedlineGoogle Scholar5. Sharma S, Grover M, Bhargava S, Samdani S, Kataria T. Post coronavirus disease mucormycosis: a deadly addition to the pandemic spectrum. J Laryngol Otol 2021;135(5):442–447. MedlineGoogle Scholar6. Arana C, Cuevas Ramírez RE, Xipell M, et al. Mucormycosis associated with COVID-19 in two kidney transplant patients. Transpl Infect Dis 2021. https://doi.org/10.1111/tid.13652. Published online May 26, 2021. MedlineGoogle Scholar7. Maini A, Tomar G, Khanna D, Kini Y, Mehta H, Bhagyasree V. Sino-orbital mucormycosis in a COVID-19 patient: A case report. Int J Surg Case Rep 2021;82:105957. MedlineGoogle Scholar8. Moorthy A, Gaikwad R, Krishna S, et al. SARS-CoV-2, Uncontrolled Diabetes and Corticosteroids-An Unholy Trinity in Invasive Fungal Infections of the Maxillofacial Region? A Retrospective, Multi-centric Analysis. J Maxillofac Oral Surg 2021;20(3):1–8. MedlineGoogle Scholar9. Ismaiel WF, Abdelazim MH, Eldsoky I, et al. The impact of COVID-19 outbreak on the incidence of acute invasive fungal rhinosinusitis. Am J Otolaryngol 2021;42(6):103080. MedlineGoogle Scholar10. Monte Junior ESD, Santos MELD, Ribeiro IB, et al. Rare and Fatal Gastrointestinal Mucormycosis (Zygomycosis) in a COVID-19 Patient: A Case Report. Clin Endosc 2020;53(6):746–749. MedlineGoogle Scholar11. Waizel-Haiat S, Guerrero-Paz JA, Sanchez-Hurtado L, Calleja-Alarcon S, Romero-Gutierrez L. A Case of Fatal Rhino-Orbital Mucormycosis Associated With New Onset Diabetic Ketoacidosis and COVID-19. Cureus 2021;13(2):e13163. MedlineGoogle Scholar12. Meshram HS, Kute VB, Chauhan S, Desai S. Mucormycosis in post-COVID-19 renal transplant patients: A lethal complication in follow-up. Transpl Infect Dis 2021. https://doi.org/10.1111/tid.13663. Published online June 3, 2021. Google Scholar13. Alekseyev K, Didenko L, Chaudhry B. Rhinocerebral Mucormycosis and COVID-19 Pneumonia. J Med Cases 2021;12(3):85–89. MedlineGoogle Scholar14. Sen M, Lahane S, Lahane TP, Parekh R, Honavar SG. Mucor in a Viral Land: A Tale of Two Pathogens. Indian J Ophthalmol 2021;69(2):244–252. MedlineGoogle Scholar15. Rao R, Shetty AP, Nagesh CP. Orbital infarction syndrome secondary to rhino-orbital mucormycosis in a case of COVID-19: Clinico-radiological features. Indian J Ophthalmol 2021;69(6):1627–1630. MedlineGoogle Scholar16. El-Kholy NA, El-Fattah AMA, Khafagy YW. Invasive fungal sinusitis in post COVID-19 patients: a new clinical entity. Laryngoscope 2021. https://doi.org/10.1002/lary.29632. Published online May 19, 2021. MedlineGoogle Scholar17. Sai Krishna D, Raj H, Kurup P, Juneja M. Maxillofacial Infections in Covid-19 Era-Actuality or the Unforeseen: 2 Case Reports. Indian J Otolaryngol Head Neck Surg 2021;1-4:1-4. Google Scholar18. Revannavar SM, P S S, Samaga L, v K V. COVID-19 triggering mucormycosis in a susceptible patient: a new phenomenon in the developing world? BMJ Case Rep 2021;14(4):e241663. MedlineGoogle Scholar19. Veisi A, Bagheri A, Eshaghi M, Rikhtehgar MH, Rezaei Kanavi M, Farjad R. Rhino-orbital mucormycosis during steroid therapy in COVID-19 patients: A case report. Eur J Ophthalmol 2021. https://doi.org/10.1177/11206721211009450. Published online April 10, 2021. MedlineGoogle Scholar20. Pakdel F, Ahmadikia K, Salehi M, et al. Mucormycosis in patients with COVID-19: A cross-sectional descriptive multicentre study from Iran. Mycoses 2021. https://doi.org/10.1111/myc.13334. Published online June 7, 2021. MedlineGoogle Scholar21. Khatri A, Chang KM, Berlinrut I, Wallach F. Mucormycosis after Coronavirus disease 2019 infection in a heart transplant recipient - Case report and review of literature. J Mycol Med 2021;31(2):101125. MedlineGoogle Scholar22. Karimi-Galougahi M, Arastou S, Haseli S. Fulminant mucormycosis complicating coronavirus disease 2019 (COVID-19). Int Forum Allergy Rhinol 2021;11(6):1029–1030. MedlineGoogle Scholar23. Ahmadikia K, Hashemi SJ, Khodavaisy S, et al. The double-edged sword of systemic corticosteroid therapy in viral pneumonia: A case report and comparative review of influenza-associated mucormycosis versus COVID-19 associated mucormycosis. Mycoses 2021;64(8):798–808. MedlineGoogle Scholar24. Werthman-Ehrenreich A. Mucormycosis with orbital compartment syndrome in a patient with COVID-19. Am J Emerg Med 2021;42:264.e5–264.e8. Google Scholar25. Sarkar S, Gokhale T, Choudhury SS, Deb AK. COVID-19 and orbital mucormycosis. Indian J Ophthalmol 2021;69(4):1002–1004. MedlineGoogle Scholar26. Nehara HR, Puri I, Singhal V, Ih S, Bishnoi BR, Sirohi P. Rhinocerebral mucormycosis in COVID-19 patient with diabetes a deadly trio: Case series from the north-western part of India. Indian J Med Microbiol 2021;39(3):380–383. MedlineGoogle Scholar27. Dallalzadeh LO, Ozzello DJ, Liu CY, Kikkawa DO, Korn BS. Secondary infection with rhino-orbital cerebral mucormycosis associated with COVID-19. Orbit 2021;1-4:1-4. Google Scholar28. Mehta S, Pandey A. Rhino-Orbital Mucormycosis Associated With COVID-19. Cureus 2020;12(9):e10726. MedlineGoogle Scholar29. Johnson AK, Ghazarian Z, Cendrowski KD, Persichino JG. Pulmonary aspergillosis and mucormycosis in a patient with COVID-19. Med Mycol Case Rep 2021;32:64–67. MedlineGoogle Scholar30. Zurl C, Hoenigl M, Schulz E, et al. Autopsy Proven Pulmonary Mucormycosis Due to Rhizopus microsporus in a Critically Ill COVID-19 Patient with Underlying Hematological Malignancy. J Fungi (Basel) 2021;7(2):88. MedlineGoogle Scholar31. Bellanger AP, Navellou JC, Lepiller Q, et al. Mixed mold infection with Aspergillus fumigatus and Rhizopus microsporus in a severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) patient. Infect Dis Now 2021. https://doi.org/10.1016/j.idnow.2021.01.010. Published online January 27, 2021. MedlineGoogle Scholar32. Placik DA, Taylor WL, Wnuk NM. Bronchopleural fistula development in the setting of novel therapies for acute respiratory distress syndrome in SARS-CoV-2 pneumonia. Radiol Case Rep 2020;15(11):2378–2381. MedlineGoogle Scholar33. Rabagliati R, Rodríguez N, Núñez C, Huete A, Bravo S, Garcia P. COVID-19-Associated Mold Infection in Critically Ill Patients, Chile. Emerg Infect Dis 2021;27(5):1454–1456. MedlineGoogle Scholar34. Hanley B, Naresh KN, Roufosse C, et al. Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study. Lancet Microbe 2020;1(6):e245–e253. MedlineGoogle Scholar35. Kanwar A, Jordan A, Olewiler S, Wehberg K, Cortes M, Jackson BR. A Fatal Case of Rhizopus azygosporus Pneumonia Following COVID-19. J Fungi (Basel) 2021;7(3):174. MedlineGoogle Scholar36. Garg D, Muthu V, Sehgal IS, et al. Coronavirus Disease (Covid-19) Associated Mucormycosis (CAM):. Case Report and Systematic Review of Literature. Mycopathologia 2021;186(2):289–298. Google Scholar37. Pasero D, Sanna S, Liperi C, et al. A challenging complication following SARS-CoV-2 infection: a case of pulmonary mucormycosis. Infection 2020. https://doi.org/10.1007/s15010-020-01561-x. Published online December 17, 2020. MedlineGoogle Scholar38. Krishna V, Morjaria J, Jalandari R, Omar F, Kaul S. Autoptic identification of disseminated mucormycosis in a young male presenting with cerebrovascular event, multi-organ dysfunction and COVID-19 infection. IDCases 2021;25:e01172. MedlineGoogle Scholar39. Patel A, Agarwal R, Rudramurthy SM, et al. Multicenter Epidemiologic Study of Coronavirus Disease-Associated Mucormycosis, India. Emerg Infect Dis 2021;27(9):2349–2359. MedlineGoogle Scholar40. Rudramurthy SM, Hoenigl M, Meis JF, et al. ECMM/ISHAM recommendations for clinical management of COVID-19 associated mucormycosis in low- and middle-income countries. Mycoses 2021;64(9):1028–1037. MedlineGoogle Scholar41. Nam BD, Kim TJ, Lee KS, Kim TS, Han J, Chung MJ. Pulmonary mucormycosis: serial morphologic changes on computed tomography correlate with clinical and pathologic findings. Eur Radiol 2018;28(2):788–795. MedlineGoogle Scholar42. Jamadar DA, Kazerooni EA, Daly BD, White CS, Gross BH. Pulmonary zygomycosis: CT appearance. J Comput Assist Tomogr 1995;19(5):733–738. MedlineGoogle ScholarArticle HistoryReceived: June 23 2021Revision requested: July 19 2021Revision received: July 28 2021Accepted: Aug 10 2021Published online: Aug 31 2021Published in print: Jan 2022 FiguresReferencesRelatedDetailsCited ByCurrent and Emerging Knowledge in COVID-19Yeon Joo Jeong, Yu Mi Wi, Hyunjin Park, Jong Eun Lee, Si-Ho Kim, Kyung Soo Lee, 10 January 2023 | Radiology, Vol. 306, No. 2Computed tomography–based COVID–19 triage through a deep neural network using mask–weighted global average poolingHong-TaoZhang, Ze-YuSun, JuanZhou, ShenGao, Jing-HuiDong, YuanLiu, XuBai, Jin-LinMa, MingLi, GuangLi, Jian-MingCai, Fu-GengSheng2023 | Frontiers in Cellular and Infection Microbiology, Vol. 13Ultra-Low Dose CT Chest in Acute COVID-19 Pneumonia: A Pilot Study from IndiaMandeepGarg, ShritikDevkota, NidhiPrabhakar, UmaDebi, ManinderKaur, Inderpaul S.Sehgal, SahajalDhooria, AshishBhalla, Manavjit SinghSandhu2023 | Diagnostics, Vol. 13, No. 3Residual Lung Lesions at 1-year CT after COVID-19Kyung Soo Lee, Yu Mi Wi, 5 October 2021 | Radiology, Vol. 302, No. 3Pulmonary Artery Pseudoaneurysm in COVID-19-Associated Pulmonary Mucormycosis: Case Series and Systematic Review of the LiteratureHimanshuPruthi, ValliappanMuthu, HarishBhujade, ArunSharma, AbhimanBaloji, Rao GRatnakara, AmanjitBal, HarkantSingh, Manavjit SinghSandhu, SunderNegi, ArunalokeChakrabarti, ManphoolSinghal2022 | Mycopathologia, Vol. 187, No. 1COVID-19-Associated Pulmonary Mucormycosis: An Underdiagnosed Entity with High MortalityValliappanMuthu, RiteshAgarwal, ArunalokeChakrabarti2022 | Mycopathologia, Vol. 187, No. 4Mortality-Related Risk Factors for Coronavirus Disease (COVID-19)-Associated Mucormycosis: a systematic review and meta-analysisVahid RezaOstovan, RezaTabrizi, HaniehBazrafshan, ZahraBahrami, HajarKhazraei, SamanehKhazraei, AfshinBorhani-Haghighi, MohsenMoghadami, MatthewGrant2022 | Current Fungal Infection Reports, Vol. 16, No. 4COVID-19 associated mucormycosis: evolving technologies for early and rapid diagnosisRachelSamson, MaheshDharne2022 | 3 Biotech, Vol. 12, No. 1Definition, diagnosis, and management of COVID-19-associated pulmonary mucormycosis: Delphi consensus statement from the Fungal Infection Study Forum and Academy of Pulmonary Sciences, IndiaValliappanMuthu, RiteshAgarwal, AtulPatel, SoundappanKathirvel, Ooriapadickal CherianAbraham, Ashutosh NathAggarwal, AmanjitBal, Ashu SeithBhalla, Prashant NChhajed, DhruvaChaudhry, MandeepGarg, RandeepGuleria, Ram GopalKrishnan, ArvindKumar, UmaMaheshwari, RavindraMehta, AnantMohan, AlokNath, DharmeshPatel, Shivaprakash MandyaRudramurthy, PuneetSaxena, NandiniSethuraman, TanuSinghal, RajeevSoman, BalamugeshThangakunam, George MVarghese, ArunalokeChakrabarti2022 | The Lancet Infectious Diseases, Vol. 22, No. 9Mucormycosis an added burden to Covid-19 Patients: An in-depth systematic reviewNaveed NazirShah, ZaidKhan, HashimAhad, Abozer Y.Elderdery, Mohammad N.Alomary, BananAtwah, ZainAlhindi, Mahdi H.Alsugoor, Ahmed M.E.Elkhalifa, ShowketNabi, Showkeen MuzamilBashir, TahirYaqub, Gulzar AhmedRather, Mohammad AzamAnsari2022 | Journal of Infection and Public Health, Vol. 15, No. 11Post-COVID-19-Invasive Pulmonary MycosisSatishSwain, KunalSharma, AnimeshRay, SurabhiVyas, GagandeepSingh, MohitJoshi, DeepaliJain, ImmaculataXess, SanjeevSinha, NaveetWig2022 | Libyan International Medical University Journal, Vol. 07, No. 01Serum iron indices in COVID‐19‐associated mucormycosis: A case–control studyMohanKumar H, PrashantSharma, Shivaprakash M.Rudramurthy, Inderpaul SinghSehgal, Kuruswamy ThuraiPrasad, Ashok KumarPannu, ReenaDas, Naresh K.Panda, NavneetSharma, ArunalokeChakrabarti, RiteshAgarwal, ValliappanMuthu2022 | Mycoses, Vol. 65, No. 1Mucormycosis co-infection in COVID-19 patients: An updateAbdullah S.Alkhamiss, Ahmed A.Ahmed, ZafarRasheed, RuqaihAlghsham, AliShariq, ThamirAlsaeed, Sami A.Althwab, SulimanAlsagaby, Abdullah S. M.Aljohani, Fahad A.Alhumaydhi, Sharifa K.Alduraibi, Alaa K.Alduraibi, Homaidan T.Alhomaidan, Khaled S.Allemailem, Raya A.Alharbi, Samar A.Alamro, Arwa M.Alqusayer, Sahim A.Alharbi, Thekra A.Alharby, Mona S.Almujaydil, Ayman M.Mousa, Sultan A.Alghaniam, Abdulrhman A.Alghunaim, RanaAlghamdi, NelsonFernández, WaleedAl Abdulmonem2022 | Open Life Sciences, Vol. 17, No. 1Radiation Exposure and Lifetime Attributable Risk of Cancer Incidence and Mortality from Low- and Standard-Dose CT Chest: Implications for COVID-19 Pneumonia SubjectsMandeepGarg, VahidKarami, JavadMoazen, ThomasKwee, Ashu SeithBhalla, DaryoushShahbazi-Gahrouei, Yu-Hsuan JoniShao2022 | Diagnostics, Vol. 12, No. 12Invasive Respiratory Fungal Infections in COVID-19 Critically Ill PatientsFrancescaRaffaelli, Eloisa SofiaTanzarella, GennaroDe Pascale, MarioTumbarello2022 | Journal of Fungi, Vol. 8, No. 4COVID-19-Associated Pulmonary MucormycosisVidyaKrishna, NitinBansal, JayminMorjaria, SundeepKaul2022 | Journal of Fungi, Vol. 8, No. 7Recommended Articles Disorders with Ophthalmic and Thoracic InvolvementRadioGraphics2024Volume: 44Issue: 7Imaging Spectrum of Invasive Fungal and Fungal-like InfectionsRadioGraphics2017Volume: 37Issue: 4pp. 1119-1134Radiographic and CT Features of Viral PneumoniaRadioGraphics2018Volume: 38Issue: 3pp. 719-739Thin-Section Chest CT Imaging of COVID-19 Pneumonia: A Comparison Between Patients with Mild and Severe DiseaseRadiology: Cardiothoracic Imaging2020Volume: 2Issue: 2Current and Emerging Knowledge in COVID-19Radiology2023Volume: 306Issue: 2See More RSNA Education Exhibits Uncommon Causes of Interlobular Septal Thickening: How to Tell Them Apart?Digital Posters2022Disorders with Ocular and Thoracic InvolvementDigital Posters2022Looking For A Sign?: A Case-based Quiz Of Classic Signs And Patterns Of Lung InfectionsDigital Posters2021 RSNA Case Collection Vascular and bronchiole dilation in COVID-19 pneumoniaRSNA Case Collection2020Pulmonary Tuberculosis RSNA Case Collection2021Resolving COVID-19 pneumonia over timeRSNA Case Collection2020 Vol. 302, No. 1 Metrics Altmetric Score Open AccessThis article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. 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