[A case of mycotic sphenoidal sinusitis with stone formation]

A 40-year-old white female was seen with the chief complaint of recurrent episodes of severe pulsating occipital headache. The headache was temporarily controlled with the treatment of antibiotics only to recur. Sinus X-ray revealed an increased radio-opacity in the left sphenoidal sinus. The sinus walls showed sclerotic reaction. X-Ray CT demonstrated a small piece of metallic density within the soft-tissue density. Intranasal sphenoidotomy was performed under general anesthesia. A small piece of stone, measuring 3 X 2 X 1.5mm, was found in the sphenoidal sinus, with purulent discharge and caseous concrements. Histopathologic examination of the caseous concrements demonstrated fungal hyphae with branching and septate suggesting Aspergillus sp. Chemical analysis of the stone (3mg dried weight) was done and it consisted of calcium phosphate (88%) and calcium carbonate (12%). Postoperative course for five years was uneventful, and postop. CT confirmed the aerated sphenoidal sinus.