Pulmonary mucormycosis (PM) is a rapidly spreading angioinvasive fungal infection with a high mortality rate. Despite advances in treatment, optimal management remains uncertain. Aggressive optimization of host factors such as glycemic control and reduction of immunosuppression is recommended. The basic antifungal strategy is induction with liposomal amphotericin B (L-AMB), followed by oral maintenance therapy with posaconazole or isavuconazole. Nuances such as L-AMB dosing, timing and duration of therapy, drug interactions, and monitoring of drug levels are addressed. Combination antifungal therapies, new drugs, and adjunctive methods such as inhaled antifungals, immunomodulation, bronchoscopic interventions, and iron chelation are being investigated. Surgery is assessed according to indications, timing and perioperative risks. Special guidelines apply to children, pregnant women, patients with chronic liver or kidney disease, and transplant recipients.