Non-invasive fungal sinusitis

Case contributed by Dr Alborz Jahangiri

Presentation

Chronic sinusitis and facial pain in a patient who failed multiple oral antibiotic courses in the last 6 months.

Patient Data

Age: 35
Gender: Male
Modality: CT

FRONTAL SINUSES: Mucosal thickening and near complete frontal sinus opacification bilaterally. There is a "double density" appearance to the mucosal thickening.The frontal recess is opacified bilaterally.

ETHMOID AIR CELLS: Almost complete mucosal thickening in the anterior and posterior air cells bilaterally. There is a "double density" appearance to the mucosal thickening.

MAXILLARY SINUSES: Almost complete mucosal thickening bilaterally. There is an air fluid level bilaterally. The osteomeatal complex is opacified bilaterally.

SPHENOIDS:  There is hypoplasia of the right sphenoid sinus with associated right paramedian position of the intersinus septum. There is near total mucosal thickening of the right sphenoid sinus. There is minimal mucosal thickening on the left. The sphenoethmoidal recess is opacified on the right and the left.

NASAL CAVITY:  The nasal septum is central. There is near complete mucosal thickening on the right and left superiorly. There is moderate thickening of the inferior turbinate on the left. The posterior nasal space appears clear. 

Case Discussion

Severe pan sinus mucosal thickening and the "double density" appearance to the mucosal thickening indicates a non-invasive fungal sinusitis.

Differential diagnosis:

  • allergic fungal sinusitis (AFS): is the most common form and involves multiple paranasal sinuses with centrally hyperdense content on CT
  • paranasal sinuses mycetoma: usually only involves the maxillary sinus and ethmoid and frontal sinuses are less commonly affected. Soft tissue density with/without calcification is a diagnostic feature on CT
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Case Information

rID: 45939
Case created: 14th Jun 2016
Last edited: 14th Jun 2016
System: Head & Neck
Inclusion in quiz mode: Included

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