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Chronic invasive fungal sinusitis

Case contributed by Abiola Ayodele
Diagnosis certain

Presentation

Progressive right visual loss. Patient had liver transplant a year prior to presentation.

Patient Data

Age: 60 years
Gender: Male

A heterogeneously enhancing soft tissue mass in the right ethmoidal sinus causing destruction of its lateral wall/ medial wall of the right orbit. There is a large extra sinus component extending into the right orbit. Encasement of the medial rectus muscle, superior rectus muscle and the optic nerve with associated proptosis. No intracranial extension is seen.

The left orbit and its contents appear normal.

Case Discussion

CT features suggestive of chronic invasive fungal sinusitis include opacification of the affected sinus, relative lack of expansion of the affected sinus, bony erosion and a large extra sinus component of the disease. This patient presented with progressive visual loss one year post liver transplant. CT findings are those of a right ethmoidal sinus mass with intra orbital extension which was histologically proven to be an invasive fungal sinusitis.

Histology report:

Histologic sections show broad, non septae hyphae branching at 90 degrees, accompanied by numerous neutrophils and histiocytes within granulation tissue.

Diagnosis: Invasive fungal sinusitis.

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