Allergic fungal sinusitis

Case contributed by Dalia Ibrahim
Diagnosis almost certain

Presentation

Chronic left nasal obstruction and discharge

Patient Data

Age: 25 years
Gender: Male
ct
This study is a stack
Coronal
bone window
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Axial bone
window
This study is a stack
Axial
non-contrast
This study is a stack
Coronal
non-contrast
This study is a stack
Sagittal
non-contrast
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Info

Expanded left maxillary antrum, left ethmoidal complexes and the left side of the frontal sinus. They show complete inhomogeneous opacification with hyperdense material is seen located centrally surrounded by hypodense mucosa.

mri
This study is a stack
Axial
T2
This study is a stack
Axial
T1
This study is a stack
Coronal
T1
This study is a stack
Coronal
T2
This study is a stack
Coronal
T1 C+
This study is a stack
Axial
T1 C+
This study is a stack
Sagittal
T1 C+
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Info

The examined sinuses show internal high signal at T1 WI and signal void at T2 WI.

Contrast enhancement of the mucosal lining.

No intra-cranial or intra-orbital extension.

Case Discussion

Allergic fungal sinusitis (AFS) is the most common form of fungal sinusitis and is common in warm, humid climates.

The majority sinuses show near complete opacification. On unenhanced CT the sinuses are typically opacified by centrally (often serpentinous) hyperdense material with a peripheral rim of hypodense mucosa. 

Approximately 40% of patients may have each of the following features:

  • expansion of an involved sinus
  • remodeling and thinning of the bony sinus walls
  • erosion of the sinus wall.

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