Fungal sinusitis

1. Case
presentation

2. Presented by
Dr. Razan Tariq

Omdurman Teatching Hospital

Unit MSS Safaa Alsarrag

3. Personal
history
Name: M.A.I.M
Age : 35 yrs
Gender : Male
Residence: Ombada
Occupation: shopkeeper

4. C/O
Left nasal swelling/7 months
Left nasal obstruction /4months

5. History of presenting illness:
The condition started 7 months ago
with left dorsum nasal swelling,
incedious onset,small and gradually
increase in size, associated with
pain and itching, not associated
with sinus discharge or skin
discoloration.

6. 4 months ago ,he developed left nasal
,obstruction , insidious onset,partially ,on and
off,asssociated with blood stained nasal
disgharge,not associated with snoring ,mouth
breathing,or post nasal drip

2 months latter he developed left side
epistaxis ,once, small amount, stopped
spontaneously ,not proceeded by trauma or
nose picking

7. No smell disturbance ,no sneezing or
itching
No facial pain , swelling or numbness ,no
nasal regurgitation .

8. Eye symptoms:
No epiphora ,double vision, or eye
protrusion
Oral symptoms:
No dental pain, no loose or lost tooth.

9. Symptoms of increase intra cranial p
pressure:
No headache or convulsions, no blurring of
vision, no projectile vomiting, no change in
behavior.
No symptoms related to motor or sensory
affection.

11. Ear:
No ear pain , discharge , aural fullness, tinnitus, vertigo , or hearing
impairment .
Throat:
There is mild trismus ,no odynophagia, dysphagia.
No sore throat ,change of voice
No neck swelling ,neck pain or restriction of movement .

12. Systemic review:
C.P.S:
G.I.T :
GNU :
MSK :

13. Past medical history:
No past history of similar condition
No history of hospitalization or
irradiation.
Not diabetic , hypertensive or
asthmatic.

14. 
Family history:
No family history of similar
condition or chronic illness .

15. Drug history:
Not known to be allergic to aspirin or
any drug known by him.
Not on long term medication.

16. Social history:
low socioeconomic status
there is no health insurance.

17. summary
35 years old male presented with
leftt side progressive
swelling/7months and nasal
obstruction/4months associated
with blood stained nasal discharge
No orbital , intracranial , ear or
neck symptoms.

18. Examination

19. General examination:
Pt look well , not pale, jaundice or
cyanosed
RR: 17 cycle/min
PR: 90 b/min
BP: 120/75
.

20. 
There is facial asymmetry in a form of left
side dorsal nasal swelling ,about 4*2 cm
rounded , smooth surface,well defind
edges, skin over it is normal

Normal tempreture,not tender, about 4*4
cm,hard in consistency, not attached to
skin or underlying structure

22. pulging leftt lateral nasal wall.
Vestibule normal bilaterally.
Cold spatula test:
Decrease fogging in left side
+Ve in rhight side
Nasal
examination

23. Anterior rhinoscopy: Normal vestibule
bilaaterally.
left:There is irregular mass ,at level of
inferior turbinate but cannot be
differentiate mass from it ,seem to involve
all nasal cavity sparring the septum
[narrowing nasal cavity],inner extention
cannot be assesed.
Right:normal mucosa ,middle and inferior
turbinate.
Posterior rhinoscopy:normal

25. Nasopharyngoscopy:
free

27. Bilaterally was : -
vision ,visual field ,
movement , corneal reflex and
pupillary light reflexes were
normal .
Eye
Examination:

28. Oral examination :
Normal lips. Normal teeth, gums and
buccal mucosa. Normal tongue.
There is a mass mass at junction of
soft and hard palate extending to sot
palate, about 4*6cm,well defined
edges not tender,,hard in
consistency,,smooth surface,,normal
mucosa over it,,no bony defect .
normal Soft palate mobility.
Gag reflex is present .

30. Ear examination :
Both auricles were normal . No pre or post
auricular swelling or scar , normal external
auditory canals bilaterally.
TM bilaterally dull of left side ,right TM
normal.
Rhine's test : +ve bilaterally .
Weber test is centralized .

31. Neck examination :
There was no visible or palpable masses
No limitation in neck movement .
Laryngeal crepitus is present .
Trachea central.
No lymph node enlargement

32. Normal base of tongue ,
vallecullae,normal
epiglottis,normal vocal cords
shape and mobility,pyriform
fossae free


33. * Granulomatus disease of the nose
* sinonasal malignancy
* chronic invasive rhinosinusitis
Differential diagnosis
:

34. Investigations:
General investigation:
C.B.C
H.B : 15.1 gdl
TWBC : 5 .4
U.G : normal
ESR:

35. Imaging
CT scan : Nose and PNS

39. .

THANKS FOR LISTINING