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Differences in clinical and imaging presentation of maxillary sinus fungus ball with and without intralesional
Pei-Wen Wu1,2, Ta-Jen Lee1,3,4, Shih-Wei Yang2,3,5
1Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan, ROC.
Abstract:
Maxillary sinus fungal balls (MSFBs) mostly occur in older individuals and demonstrate female predominance. Early diagnosis is important to avoid treatment delays. Intralesional hyperdensity (IH) indicates the presence of heavy metal deposition within fungal hyphae and has been the most specific characteristic of MSFB on computed tomography (CT). For those without IH on CT, the diagnosis of MSFB remains challenging. This study aimed to characterize clinical presentation of MSFB with and without IH and to study factors contributing to MSFB with no IH formation. We retrospectively identified 588 patients with MSFB. The clinical characteristics and CT findings were reviewed. Patients with unilateral MSFB had a mean age of 57.4 years and demonstrated female predominance (64.63%). The female-to-male ratio was highest at 51-60 years (2.02) and rose to 2.60 in MSFB with IH only. Compared to those with IH, MSFB without IH was significantly more common in males (OR = 2.49), in those with diabetes mellitus (DM) (OR = 1.87), adjacent maxillary odontogenic pathology (OR = 1.75). Complete opacification on CT was less common in MSFB without IH (OR = 0.60). Patients with MSFB without IH were more likely to have DM, no female predominance, adjacent maxillary odontogenic pathology, and partial opacification of the sinus, compared to those with IH. These may be helpful in better understanding of the formation of MSFBs without IH, early identification of them and prevention of post-operative recurrence.
Insights
Maxillary sinus fungal balls (MSFBs) are challenging to diagnose without intralesional hyperdensity (IH). This study identified factors like male sex and diabetes mellitus associated with MSFBs lacking IH on CT scans.
Area of Science:
- Otolaryngology
- Radiology
- Mycology
Background:
- Maxillary sinus fungal balls (MSFBs) predominantly affect older individuals, with a notable female predominance.
- Intralesional hyperdensity (IH) on computed tomography (CT) is a specific indicator of MSFB, aiding diagnosis.
- Diagnosis of MSFB without IH on CT presents significant challenges, potentially delaying treatment.
Purpose of the Study:
- To characterize the clinical presentation of MSFBs with and without IH.
- To identify factors contributing to the formation of MSFBs lacking IH.
Main Methods:
- Retrospective review of clinical characteristics and CT findings in 588 patients with MSFB.
- Comparative analysis of patients with and without IH on CT scans.
- Statistical analysis to determine odds ratios (OR) for associated factors.
Main Results:
- MSFBs without IH were significantly more prevalent in males (OR=2.49), individuals with diabetes mellitus (DM) (OR=1.87), and those with adjacent maxillary odontogenic pathology (OR=1.75).
- Complete sinus opacification on CT was less common in MSFBs without IH (OR=0.60).
- Patients with MSFBs without IH exhibited a lack of female predominance and were more likely to have DM and adjacent odontogenic issues.
Conclusions:
- MSFBs without IH present differently than those with IH, often associated with male sex, DM, and odontogenic pathology.
- Recognizing these distinct features can improve early identification and management of MSFBs lacking IH.
- Understanding these factors may aid in preventing post-operative recurrence.
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