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Aspergillosis of the paranasal sinuses
Abstract:
The CT appearances of 13 cases of pathologically proven aspergillosis involving paranasal sinuses were reviewed. Symptoms included rhinorrhea, nasal obstruction, headache, facial pain and foul smell from the nose. At operation, these lesions appeared yellowish, brownish, grey or black in colour, and contained dirty or muddy material. Microscopic examination of the tissue removed showed an Aspergillus ball with chronic inflammation but without invasion of the nasal or sinus mucosa in 6 cases, and tissue invasion with necrosis and inflammation in 7. The structures involved, in order of frequency, were: maxillary sinus, nasal cavity, ethmoid sinus, orbit and cavernous sinus. The orbit was involved in 2 cases, therefore categorized as invasive; the other 11 cases were non-invasive as judged by CT. Calcification was seen in the lesions of 9 cases. In most cases the adjacent bony structures showed areas of erosion and sclerosis. Aspergillosis should be suspected in the presence of a mass in the paranasal sinuses or nasal cavity with calcification within it, which may not appear solid or dense and is separate from the walls of the sinus.
Insights
Computed tomography (CT) reveals characteristic signs of fungal sinusitis, particularly aspergillosis, in the paranasal sinuses. Early detection through CT imaging aids in differentiating invasive from non-invasive fungal infections.
Area of Science:
- Radiology
- Otolaryngology
- Mycology
Background:
- Paranasal sinus aspergillosis is a fungal infection that can present with diverse clinical and imaging findings.
- Accurate diagnosis is crucial for appropriate management and preventing complications.
Purpose of the Study:
- To review and characterize the computed tomography (CT) appearances of pathologically proven paranasal sinus aspergillosis.
- To correlate CT findings with clinical presentation and pathological examination.
Main Methods:
- Retrospective review of CT scans from 13 patients with pathologically confirmed aspergillosis of the paranasal sinuses.
- Correlation of imaging findings with surgical observations and histopathological results.
Main Results:
- Common symptoms included rhinorrhea, nasal obstruction, headache, facial pain, and nasal foul smell.
- CT findings showed calcification in 9 cases and bony erosion/sclerosis in most cases.
- Invasive disease (orbit involvement) was seen in 2 cases, while 11 were non-invasive.
Conclusions:
- CT is valuable in diagnosing paranasal sinus aspergillosis, identifying calcification and bony changes.
- Aspergillosis should be suspected with paranasal sinus masses containing calcification, especially if not dense or separate from sinus walls.