 Good morning, my respected teachers and my dear colleagues. Today, my topic of presentation is Computed Tomographic Findings of Invasive Mucormycosis in COVID-19 patients on steroid therapy at a tertiary care center. Now, as we all know, mucormycosis is a systemic fungal infection caused by member of the class zygomycetes of order mucorals. It is seen in patients debilitated by immune or metabolic disorders. Phagocytes are the main defense mechanism against mucormycosis. And they do so by preventing the multiplication of fungal sports. This process is inhibited by corticosteroids. Angioinvasiveness with vessel thrombosis and tissue necrosis is a characteristic feature of mucormycosis. Uncontrolled diabetes and the use of corticosteroids for the treatment of COVID-19 are the main risk factors in the current scenario. Other risk factors are long term neutropenia, invasive intravenous drug use, malnutrition, stem cell or cellular organ transplantation, severe skin damages, notably by burns and surgical suture sites. COVID-19, as we know, has wreaked havoc on the world since December 2019. Of late, the situation has been complicated with the rise in number of co-infections, notably with mucormycosis, especially in India. Mucormycosis has a high mortality rate of over 50%. Recently, chest CT findings, along with CT of the PNS, has been given a high accurate and non-invasive mortality of imaging with early treatment of invasive pneumonia and immunocompromised patients. Final diagnosis is made on clinical details of imaging findings and histopathology. We came across six cases of invasive mucormycosis following COVID-19 infection with varying involvement of the lung, panchina, panacea, asynosis and orbits. Histopathological evaluation of nasal specimen of all six cases was done on potassium hydroxide wet mouth for conformation. Their medical records, clinical data and demographics were reviewed along with radiological and histopathological findings. All the patients were previously treated or currently undergoing treatment for COVID-19 at our hospital and they had subsequently developed symptoms, mainly facial pain, nasal blockage without discharge, epistaxis, chemosis and swelling of the eye with even loss of vision in one patient. The mean age of involvement was around 54 years. Five of the six patients were diabetic. All six had received steroids for at least 10 days and remdesperate had been administered to five patients. All the patients except one had comorbidities like hypertension, CKD and COPD. Two of the patients had severe COVID-19 infection while the rest had moderate infection based on past CT CBRT score. CT of the panacea, asynosis and thorax revealed thickening of the mucosa of the panacea asynosis with adjacent bone erosion and even extension into the orbit in some cases. A few cases also revealed a central cavity with irregular intersecting lines in the lungs surrounded by consolidation referred to classically as the burs nest sign. This is a representation of the case findings in tabular form which has been discussed further. Now mucormicosis is an invasive fungal infection first discovered by Paltof in 1885. Although it can involve different organs the most common type is the rhinocerebral form. In our case series we observed six patients with recent history of proven moderate to severe COVID-19 infection. Five were diabetic with one having coexisting CKD and other suffering from COPD. All had received systemic steroid therapy for 10 days at least. CT of the head and PNS showed obliteration of the left retranial pain with mucosal thickening in the adjacent maxillary anterum and partial obliteration of the retranial pattern on the right with near complete or pacification of the maxillary sinus which raises the suspicion of it being something other than a case of simple sinusitis. This is the figure with obliteration of the left retranial pattern partially on the right with mucosal thickening in both the maxillary sinus. Complete or pacification of the adjacent maxillary sinus and MTA model SS with internal foci of air without an air fluid level was appreciated in another patient. Corresponding osteomyatrial unit was blocked. A small defect was noted in the postulateral and infromedial maxillary wall of the same side. In one of the cases we found mucosal thickening in bilateral sphenoid and maxillary sinus and left itmoid sinus. Irregular outline soft tissue density lesion was seen at the infromedial aspect of the left orbit and left side of the mid cheek entered to the left maxillary anterum as shown in figure two. The mucosal thickening was also noted on the right side. There is erosion of the medial wall of the maxillary anterum with thinning of the inferior and medial wall of the orbit. The lesion communicated with the left anti-itmoid sinus through small bone erosions. There was inflammatory changes in the left retro maxillary region. Both maxillary osteo were blocked with left side proclosis. In two of our cases we did an HRCT thorax. We found few thick walled cavitating lesion with pipe brotic capacities in one. In another we found cavities surrounded by a dense area of consolidation with few intersecting irregular areas of stranding resembling the classical reverse halosine or the bird's nest sign. This is the bird's nest sign and this is another why we found the thick walled cavitating lesion with few nodular opacities in the right lobe. Patchy pipe brotic opacities were seen throughout the lab. Now Gamba et al previously showed that the early disease manifested as mucosal thickening on CT scan usually without a fluid level. Silverman also described the presence of retro-anthro-pacial and orbital patch stranding indicating the aggressive nature of the infection. A study is done by Sethi et al found peripherally arranged down glass opacities with surrounding athletic changes in all the lobes of bilateral lumps. Typical for COVID-19 infection with thickening in right it model but bilateral maxillary assignments with a collection in the right maxillary sinus and small defect in postulately infomical maxillary wall on the right side and minimal soft tissue thickening in right orbit abutting the infrared rectus muscle. In a study done by Mandi et al they found that the most frequent CT findings were consolidation and cavitation with reverse halosine seen in two patients. All were treated at Department of Autorhinolaryngology the surgical specimens sent to histopathology and one gross specimen we found of maxilla and necrotic material with congestion seen throughout the specimen. In a study done by Sunil et al they found that the areas of inflamed cremation tissue hemorrhagen congestion was seen in the gross specimen. Necrotic areas showed colonies of mucormycosis consisting of broad noncepted hyphae. The P.A.'s Gropot's methamphetamine silver stain also showed fungal hyphae of mucormycosis. There's a gross specimen with histopathological findings. In conclusion, we'd like to propose that the patients with severe or moderate COVID-19 infection compromise immunity due to whatever cost who have received prolonged systemic steroid therapy they are most susceptible to mucormycosis because of the impaired defense mechanism. The early diagnosis can be made for imaging features of PNS and HRCT thorax which can aid the treating clinician for prompt treatment of secondary fungal infection and substantially reduce morbidity and mortality. Thank you.