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Isolated fungus ball in sphenoid sinus: tips and pitfalls of T 1 hyperintense lesions

Teresa Popolizio1, Marco Perri1, Rosario Francesco Balzano2

  • 1Department of Radiology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Puglia, Italy.

BJR Case Reports
|October 27, 2018
PubMed

Insights

Isolated sphenoid sinus fungus balls are rare. This case highlights the importance of considering fungal balls in T1 hyperintense sphenoid sinus lesions, even after initial misdiagnosis.

Area of Science:

  • Otolaryngology
  • Radiology
  • Pathology

Background:

  • Isolated sphenoid sinus fungus ball is an exceptionally rare clinical diagnosis.
  • Computed tomography (CT) and magnetic resonance imaging (MRI) are crucial for diagnosing sphenoid sinus pathologies.
  • Evaluating extracompartmental invasion often requires advanced imaging techniques like MRI.

Observation:

  • An elderly female presented with headache and a sphenoid sinus mass initially diagnosed as sinusitis via CT.
  • Recurrence of symptoms after one year prompted a brain MRI, revealing a T1 hyperintense lesion.
  • A subsequent CT scan identified calcifications within the mass, leading to surgical investigation.

Findings:

  • Histopathological examination confirmed the presence of a fungal ball within the sphenoid sinus.
  • The lesion was initially misdiagnosed due to its presentation mimicking simple sinusitis.
  • MRI T1-weighted imaging revealed characteristic hyperintensity of the soft tissue mass.

Implications:

  • Fungal balls should be included in the differential diagnosis for T1 hyperintense lesions within the sphenoid sinus.
  • This case underscores the utility of MRI in characterizing complex sphenoid sinus masses.
  • Accurate and timely diagnosis of sphenoid sinus fungal balls is essential for appropriate patient management.

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