Allergic fungal sinusitis

Case contributed by Dr Ammar Haouimi

Presentation

History of chronic sinusitis in an asthmatic patient with a right nasosinusal mass on ENT exam.

Patient Data

Age: 30 years
Gender: Male
CT

Soft tissue filling the right sinuses (maxillary, sphenoid, frontal, and ethmoid cells), isodense to the muscles with central areas mildly hyperdense. There is a remodeling and thinning of the bone sinus wall with the expansion of the maxillary ostium into the ipsilateral nasal fossa.

MRI

The MRI sequences demonstrate a hypointense signal on T1WI, markedly hypointense signal on T2WI mainly of the maxillary antrum and sphenoid sinus (due to the high concentration of various metals by the fungal organisms as well as the high protein content) with peripheral inflamed mucosal thickness of intermediate signal on T1WI, high signal on T2WI,  enhanced on post-contrast sequences. The right ethmoid cells as well as the ipsilateral nasal fossa show also areas of very low signal on T2WI. Moderate peripheral mucosal thickening of the left maxillary antrum.

Case Discussion

CT and MRI features are highly suggestive of an allergic fungal sinusitis 

The allergic fungal sinusitis is considered as the most common fungal sinusitis. The treatment includes local excision with steroid therapy. The fungal therapy is used in some cases.

Additional contributor: Dr. R Bouguelaa, MD

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Case information

rID: 65888
Published: 29th Jan 2019
Last edited: 14th Aug 2019
System: Head & Neck
Inclusion in quiz mode: Included
Institution: Aurès Medical Imaging Center - Batna Algeria

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