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Published on: March 9, 2018
Incidental Findings of Asymptomatic Fungal Infection
Nisha Manila1, Madhu Nair2, Hui Liang3
1Oral and Maxillofacial Radiology, Department of Diagnostic Sciences, Louisiana State University School of Dentistry, New Orleans, Louisiana, USA.
Abstract:
Fungal sinusitis of the paranasal sinuses is a rare infection in healthy individuals but is relatively common in immunocompromised patients. It is often misdiagnosed and frequently a severe disease, as a few forms of it are linked with a higher mortality rate. Effective handling necessitates a speedy analysis and often counts on radiological findings. On cone-beam computed tomography (CBCT) analysis, a bulky polypoid-shaped lesion with a density close to that of soft tissue in CBCT was visualized in the right ethmoid and sphenoid sinuses. There was a significant expansion of the borders of the right ethmoid sinus, and discontinuity or perforation of the sphenoid sinus floor was suspected from CBCT images. Non-contrasted multi-detector computed tomography (MDCT) exhibited opacification and extension of the lesion into the majority of sinuses with dense inspissated materials in the center, which resembled radiographic features of invasive fungal sinusitis. Computed tomography (CT) scan of the maxillofacial region, specifically paranasal sinuses, plays a considerable role in diagnosing fungal sinusitis. In a majority of cases, fungal sinusitis is noticed and diagnosed in immunocompromised patients. However, it is also seen in healthy patients in very rare circumstances, similar to the patient in this report. If the patient is treated rapidly, the prognosis is fair. We present a case of fungal sinusitis in an otherwise healthy young male patient to increase awareness among dental professionals.
Insights
Fungal sinusitis, a rare but severe infection, can affect healthy individuals and requires prompt diagnosis. This case highlights its presentation in an immunocompetent patient, emphasizing the role of CT scans.
Area of Science:
- Otolaryngology
- Radiology
- Infectious Diseases
Background:
- Fungal sinusitis is uncommon in healthy individuals but prevalent in immunocompromised patients.
- It is often misdiagnosed and can be severe, with some forms having high mortality rates.
- Accurate diagnosis relies on prompt analysis and radiological findings.
Observation:
- Cone-beam computed tomography (CBCT) revealed a bulky, soft-tissue-density lesion in the ethmoid and sphenoid sinuses.
- CBCT suggested expansion of the ethmoid sinus and potential perforation of the sphenoid sinus floor.
- Multi-detector computed tomography (MDCT) showed opacification, central dense material, and extension into multiple sinuses.
Findings:
- Radiographic features on CT scans were consistent with invasive fungal sinusitis.
- The case presented is fungal sinusitis in an otherwise healthy young male.
- Computed tomography (CT) of the paranasal sinuses is crucial for diagnosis.
Implications:
- Early diagnosis and treatment are critical for a favorable prognosis.
- Awareness among dental professionals is important for timely identification.
- This case underscores that fungal sinusitis can occur in immunocompetent individuals.
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