Brief description with key imaging findings allowing differential diagnosis of various forms of fungal sinusits.
From Radiopaedia.org and Diagnostic Imaging: Head and Neck by H. Ric, Harnsberger.
4. chronic severe noninvasive form
immunocompetent, nondiabetic
atopic patient, asthma
long-standing symptoms of chronic RS
facial deformity, diplopia
serum eosinophilia, elevated IgE
Maria Cucos MD
5. CT with soft tissue and bone window best
multiple sinuses, ethmoid > maxillary
hyperdense nonenhancing material
peripheral mucosa enhances
bone expansion +/- erosion
Maria Cucos MD
9. also called mycetoma, fungus ball, aspergilloma
immunocompetent
non-atopic
minimally symptomatic
Maria Cucos MD
10. 1 sinus, commonly maxillary
with high density mass with Ca++
which may be ovoid or conform to sinus shape
a/w chronic osteitis
fungus ball is hypo T1, hypo T2
coronal NECT best
Maria Cucos MD
11. DDX
chronic rhinosinusitis
less likely to appear mass like
affects > 1 sinus
Ca++ more rare
allergic fungal sinusitis
atopy
high density material, low T1, T2
but with bone expansion
Maria Cucos MD
13. the same as chronic noninvasive fungal sinusitis
high density material + chronic osteitis
+
invasiveness of fungal mass
extrasinus extension +/- bone erosion
Maria Cucos MD
15. acute onset in immunosuppressed patient
spread occurs via vascular invasion
can be fatal
Maria Cucos MD
16. dense secretions
bone destruction
ill-defined spread to soft tissues
pterygopalatine fossa, masticator space, infratemporal fossa
orbit, intracranial fossa
! infiltration of fat planes can be present w/o bone erosion
via vascular channels
Maria Cucos MD
17. CECT with soft tissue and bone window
soft tissue and muscles may enhance
MRI, T1+C FS if suspected orbital and intracranial complications
leptomeningitis, epidural abscess, subdural empyema, brain abscess
MRA, MRV
arterial pseudoaneuryrsm, thrombosis, dissection + brain ischemia
cavernous sinus thrombosis
! always look at cavernous sinus, cavernous ICA, and basilar artery
with sphenoid sinusitis
Maria Cucos MD
18. DDX destructive sinonasal lesion with soft tissue involvement
acute invasive fungal sinusitis
acute rhinosinusitis
chronic invasive fungal sinusitis
granulomatosis with polyangiitis (Wegener’s)
sinonasal lymphoma
sinonasal carcinoma
Maria Cucos MD
19. Questions to ask with fungal sinusitis
is the patient immunosuppressed?
is the patient atopic?
is the patient symptomatic?
one or more sinuses involved?
Maria Cucos MD
20. Maria Cucos MD
allergic fungal sinusitis chronic noninvasive fungal sinusitis
atopy, asthma
chronic symptoms
multiple sinuses, ethmoidal +
hyperdense material
bone expansion +/- erosion
noninvasive
immunocompetent/mildly immunosuppressed
mildly symptomatic
one sinus, maxillary +
hyperdense material
osteosclerosis +/- volume reduction
noninvasive
chronic invasive fungal sinusitis acute invasive fungal sinusitis
diabetic patient
chronic symptoms
hyperdense material
osteosclerosis + bone erosions
extra-sinus invasion
immunosuppressed, diabetic
acute dramatic symptoms
hyperdense material less prominent
bone erosions, no osteosclerosis
extra-sinus invasion
21. Remember
context is important
consider AIFS in immunosupressed and diabetic patients
consider CNFS in immunocompetent patients or only
mildly immunosuppressed
Maria Cucos MD
22. Remember
always look for signs of invasive disease
soft tissue infiltration/invasion
bone destruction
Maria Cucos MD
23. Remember
consider AIFS in immunosuppressed patient
with maxillary disease + infiltrated periantral fat even if
no bone erosion is present
Maria Cucos MD