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The significance of Computed Tomography in invasive paranasal mucormycosis
G Slonimsky1, E Slonimsky2, A Yakirevitch1
1Department of Otolaryngology-Head and Neck Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
Introduction:
Early diagnosis of acute invasive fungal rhinosinusitis (AIFR) is crucial for patients prognosis and may reduce the extent of surgical debridement. Initial evaluation usually includes paranasal Computed Tomography (CT), with an emphasis on bony erosion which is considered a specific but insensitive radiologic sign. Most studies made no distinction between Aspergillus and Mucor species while addressing CT findings. In this study, we seek to evaluate whether bony erosion on paranasal CT is a significant and reliable finding in the initial evaluation of invasive paranasal mucormycosis.
Methods:
A retrospective review of pre-operative non-contrast craniofacial CT scans of patients diagnosed with acute invasive fungal rhinosinusitis (AIFR) caused by Mucor species for the presence of bony erosion.
Results:
A total of 13 patients (9 males, 4 females) were included. Twelve patients were immunosuppressed due to various hematological malignancies. Six patients underwent debridement due to gross intraoperative findings of bony fungal invasion, but only one patient had evidence of bony erosion on the pre operative paranasal CT.
Conclusion:
Bony erosion on paranasal CT is an exceptionally insensitive radiologic sign for establishing or rejecting the diagnosis of Mucor induced AIFR. The mainstay of confirming or rejecting the diagnosis of AIFR is by physical examination, endoscopy and oriented biopsy of suspicious mucosal lesions.
Insights
Bony erosion on CT scans is an unreliable indicator for diagnosing invasive fungal rhinosinusitis caused by Mucor species. Diagnosis relies on physical exams, endoscopy, and biopsies, not just imaging findings.
Area of Science:
- Medical Imaging
- Otolaryngology
- Infectious Diseases
Background:
- Acute invasive fungal rhinosinusitis (AIFR) requires early diagnosis to improve patient outcomes and minimize surgical intervention.
- Paranasal CT scans are used for initial evaluation, focusing on bony erosion, a sign that is specific but not sensitive.
- Previous studies often did not differentiate between Aspergillus and Mucor species in CT findings.
Purpose of the Study:
- To determine if bony erosion on paranasal CT is a significant and reliable indicator in the initial assessment of invasive fungal rhinosinusitis caused by Mucor species.
Main Methods:
- Retrospective review of pre-operative non-contrast craniofacial CT scans.
- Analysis focused on patients diagnosed with AIFR caused by Mucor species.
- Assessment for the presence of bony erosion.
Main Results:
- 13 patients (9 male, 4 female) were included; 12 had immunosuppression due to hematological malignancies.
- Six patients required debridement due to intraoperative findings of bony fungal invasion.
- Only one patient exhibited bony erosion on pre-operative paranasal CT.
Conclusions:
- Bony erosion on paranasal CT is a highly insensitive sign for diagnosing Mucor-induced AIFR.
- Confirmation or exclusion of AIFR diagnosis depends on physical examination, endoscopy, and targeted biopsy of suspicious lesions.
