Paranasal sinus mycetoma

Changed by Yuranga Weerakkody, 20 Oct 2015

Updates to Article Attributes

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Mycetoma in chronic fungal sinusitis is an indolent, non-invasive fungal colonisation of the paranasal sinuses.  

Pathology

Pathogenesis is thought to be a cascade of processes from deficient mucociliary clearance leading to sinus colonisation and chronic inflammatory response. The patient may only have a mild symptom or be asymptomatic. 

Radiographic features

CT

Commonly only a single sinus is affected with the predilection for the maxillary sinus follow by the sphenoid sinus. The frontal and ethmoid is less often affected. A clue to the diagnosis includes soft tissue density within the sinus with/without foci of calcific deposit. Post obstructive change may be observed if the mycetoma obstructs the sinus drainage pathway leading to partial or complete sinus opacification 2

Evidence of chronic inflammation with sclerosis and thickening of the wall of the paranasal sinuses. Careful evaluation of the sinus cavity is prudent to exclude bone erosion that is not a feature of mycetoma / chronic fungal sinusitis rather a feature of acute invasive fungal sinusitis 2.

MRI

MRI signal characteristics of mycetomas reflect the internal content of the mycelia, vegetative part of a fungus consisting of a conglomerate of hyphae. This contains primarily carbohydrates with some glycoproteins, macromolecular proteins, and iron and manganese.

Mycetoma appear as low signal intensity on both T1WI and T2WI with T2WI being more conspicuous. The presences of paramagnetic elements further shorten the relaxation times, and this can be a highlight on the susceptibility weighted sequence 5.

Chronic inflammatory change of the sinus mucosa may enhance on post contrast T1WI. 

See also

  • -<p><strong>Mycetoma in chronic fungal sinusitis</strong> is an indolent, non-invasive fungal colonisation of the <a href="/articles/paranasal-sinuses">paranasal sinuses</a>.  </p><h4>Pathology</h4><p>Pathogenesis is thought to be a cascade of processes from deficient mucociliary clearance leading to sinus colonisation and chronic inflammatory response. The patient may only have a mild symptom or be asymptomatic. </p><h4>Radiographic features</h4><h5>CT</h5><p>Commonly only a single sinus is affected with the predilection for the maxillary sinus follow by the sphenoid sinus. The frontal and ethmoid is less often affected. A clue to the diagnosis includes soft tissue density within the sinus with/without foci of calcific deposit. Post obstructive change may be observed if the mycetoma obstructs the sinus drainage pathway leading to partial or complete sinus opacification <sup>2</sup>. </p><p>Evidence of chronic inflammation with sclerosis and thickening of the wall of the paranasal sinuses. Careful evaluation of the sinus cavity is prudent to exclude bone erosion that is not a feature of mycetoma / chronic fungal sinusitis rather a feature of acute invasive fungal sinusitis <sup>2</sup>.</p><h5><strong>MRI</strong></h5><p>MRI signal characteristics of mycetomas reflect the internal content of the mycelia, vegetative part of a fungus consisting of a conglomerate of hyphae. This contains primarily carbohydrates with some glycoproteins, macromolecular proteins, and iron and manganese.</p><p>Mycetoma appear as low signal intensity on both T1WI and T2WI with T2WI being more conspicuous. The presences of paramagnetic elements further shorten the relaxation times, and this can be a highlight on the susceptibility weighted sequence <sup>5</sup>.</p><p>Chronic inflammatory change of the sinus mucosa may enhance on post contrast T1WI. </p><h4>See also</h4><ul><li><a href="/articles/fungal-sinusitis">fungal sinusitis</a></li></ul>
  • +<p><strong>Mycetoma in chronic fungal sinusitis</strong> is an indolent, non-invasive fungal colonisation of the <a href="/articles/paranasal-sinuses">paranasal sinuses</a>.  </p><h4>Pathology</h4><p>Pathogenesis is thought to be a cascade of processes from deficient mucociliary clearance leading to sinus colonisation and chronic inflammatory response. The patient may only have a mild symptom or be asymptomatic. </p><h4>Radiographic features</h4><h5>CT</h5><p>Commonly only a single sinus is affected with the predilection for the maxillary sinus follow by the sphenoid sinus. The frontal and ethmoid is less often affected. A clue to the diagnosis includes soft tissue density within the sinus with/without foci of calcific deposit. Post obstructive change may be observed if the mycetoma obstructs the sinus drainage pathway leading to partial or complete sinus opacification <sup>2</sup>. </p><p>Evidence of chronic inflammation with sclerosis and thickening of the wall of the paranasal sinuses. Careful evaluation of the sinus cavity is prudent to exclude bone erosion that is not a feature of mycetoma / chronic fungal sinusitis rather a feature of acute invasive fungal sinusitis <sup>2</sup>.</p><h5>MRI</h5><p>MRI signal characteristics of mycetomas reflect the internal content of the mycelia, vegetative part of a fungus consisting of a conglomerate of hyphae. This contains primarily carbohydrates with some glycoproteins, macromolecular proteins, and iron and manganese.</p><p>Mycetoma appear as low signal intensity on both T1WI and T2WI with T2WI being more conspicuous. The presences of paramagnetic elements further shorten the relaxation times, and this can be a highlight on the susceptibility weighted sequence <sup>5</sup>.</p><p>Chronic inflammatory change of the sinus mucosa may enhance on post contrast T1WI. </p><h4>See also</h4><ul><li><a href="/articles/fungal-sinusitis">fungal sinusitis</a></li></ul>

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