Imaging of Noninvasive and Invasive Fungal Sinusitis
Allergic Fungal Sinusitis
Fungus Ball
Acute Invasive Fungal Sinusitis
Chronic Invasive Fungal Sinusitis
Granulamatous Invasive Fungal Sinusitis
Introduction
Summary
References
IMAGES 1,2,3,4,5,6,7,8

Chronic Invasive Fungal Sinusitis

Overview:
-Inhaled fungal organisms are deposited in the nasal passageways and paranasal sinuses
-Insidious progression over several months to years in which fungal organisms invade the mucosa, submucosa,
blood vessels, and bony walls of the paranasal sinuses
-Causes significant morbidity and may even be fatal
-Common organisms include Alternaria, Aspergillus, Bipolaris, Candida, Curvularia, Mucor, and Pseudallescheria

Clinical:

-Individuals are usually immunocompetent or have a milder level of immunocompromise
-Frequent history of chronic sinusitis
-Symptoms include paranasal sinus pain, serosanguinous nasal discharge, epistaxis, and fever
-Symptoms may also include headache, lethargy, mental status changes, seizures, neurologic deficits, and
maxillofacial soft tissue swelling when complicated by intracranial or maxillofacial extension
-Characteristic association with the orbital apex syndrome consisting of proptosis, visual disturbances, and
ocular immobility

Imaging:

-Hyperdense soft tissue on non-contrast CT within one or more of the paranasal sinuses
-May be mass-like and mimic a malignancy
-Variable T1 and T2 WI signal intensity but frequently hypointense on T1 WI and very hypointense T2 WI
-Erosion and possibly expansion of the involved sinus
-Invasion of adjacent structures such as the orbit, anterior cranial fossa, and maxillofacial soft tissues
-Obliteration of the periantral fat planes about the maxillary sinus is an indicator of invasive disease
-Associated findings include meningitis, epidural abscess, cerebritis or cerebral abscess, cavernous sinus
thrombosis, osteomyelitis, mycotic aneurysm, cerebral infarct, and orbital infection

Treatment and Prognosis:

-Treatment needs to be as aggressive as for the acute invasive fungal sinusitis
-Treatment includes surgical exenteration of the affected tissues
-Systemic antifungal medication is required
-Frequent recurrence necessitates close surveillance

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