Presentation
Representation for severe headache. Daily headaches for past 2 weeks, always right sided with associated photophobia and right eye weep. No previous history of headache.
Patient Data
Rounded hyperdense, expansile lesion centered on the right sphenoid sinus. Smooth surrounding bone erosion into the right middle cranial fossa, right carotid canal and clivus. Numerous small internal calcific foci.
The lesion within the sphenoid sinus is hyperintense on T1, markedly hypointense on T2, low signal on DWI and ADC with some internal blooming foci on SWI. Thin rim of peripheral enhancement.
Case Discussion
The patient underwent functional endoscopic sinus surgery for resection of the lesion.
Microscopy: Sections show amorphous necrotic cellular debris amongst which eosinophils are present. A silver stain reveals fungal hyphae with morphology consistent with aspergillus species. There is no evidence of malignancy.
Final diagnosis: Mycetoma