Acute invasive fungal sinusitis - black turbinate sign

Case contributed by Dr Mostafa El-Feky

Presentation

Sinonasal obstruction and pain

Patient Data

Age: 70 years
Gender: Male
CT

Paranasal sinuses

Total opacification of the right maxillary antrum by thickened mucosa and retained secretions. Irregular mucosal thickening of the other right-side sinuses as well as left sphenoid and maxillary sinuses.

Osseous erosions involve the hard palate, the right pterygoid process and the posterolateral wall of the right maxillary antrum.

Obliteration of the fat planes on the right side involving the pterygopalatine fossa and retroantral pad.

MRI

Paranasal sinuses

Total opacification of the right maxillary antrum by thickened mucosa and retained secretions. Irregular mucosal thickening of other right side sinuses as well as left sphenoid and maxillary sinuses.

Post-contrast sequences show areas lack of enhancement of the right middle and inferior turbinates that gives "black turbinate sign".

No intracranial or intra-orbital extension.

Case Discussion

The lack of hyperdense material inside the involved sinuses or bony sclerotic changes with bone destruction and areas of diminished enhancement of involved turbinates on MRI (black turbinate sign) are in favor of acute invasive fungal sinusitis.

 

Case courtesy, Prof.Dr. Mohamed Eid, Professor of Radiology, Alexandria university, Egypt.

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Case information

rID: 73386
Published: 15th Mar 2020
Last edited: 15th Mar 2020
System: Head & Neck
Inclusion in quiz mode: Included
Institution: Dar El Ashaa Center

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