Nasal obstruction and discharge
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There is an expansile low - intermediate SI on TI, and hypo SI centrally on T2 W I due to dense fungal infection and shows peripheral enhancement after IV contrast injection at the left maxillary , ethemoid , frontal sinuses extend to nasal cavity. The above-mentioned lesions causing left intra orbital and dural extensions . The diagnosis was confirmed by the histopathologic evaluation of biopsy specimens .
MRI is the modality of choice to assess the fungal sinusitis and its soft tissue extension. The findings within the sinus are variables such as mucosal thickening, polyp formation and complete opacification of the sinus. The characteristic finding in MRI is a drop of signal intensity on T2 weight images. .MRI is important in the detection of complications such as dural enhancement, intracranial extension, and periorbital extension.Good history-taking and physical examination combined with computed tomography, MRI and nasal, sinus endoscopy is important for diagnosis the fungal sinusitis. Management must be early with aggressive medical and surgical treatment. Systemic antifungal should be administered and diabetic ketoacidosis or neutropenia should be corrected. Aggressive surgical debridement is usually required.