Deadly Fungi: Invasive Fungal Rhinosinusitis in the Head and Neck

Area of Science:

• Radiology
• Infectious Diseases
• Ophthalmology

Background:

• Invasive fungal rhinosinusitis (IFRS) is a severe infection with increasing incidence, linked to antibiotic and immunosuppressant use.
• Rhino-orbital cerebral mucormycosis, a form of IFRS, has reemerged globally, particularly in COVID-19 patients.
• Early detection of IFRS extrasinus involvement is critical for improving patient outcomes.

Purpose of the Study:

• To summarize the epidemiology, etiology, risk factors, and complications of IFRS.
• To review the anatomy and key diagnostic imaging features of IFRS beyond the sinonasal regions.
• To emphasize the importance of imaging in managing IFRS, especially in immunocompromised individuals.

Main Methods:

• Review of literature on IFRS epidemiology, etiology, risk factors, and complications.
• Analysis of anatomical structures and key diagnostic imaging features of IFRS.
• Focus on intra- and extrasinonasal imaging findings.

Main Results:

• IFRS can spread to intraorbital, cavernous sinus, and intracranial regions, causing severe complications like vision loss and brain abscess.
• Key imaging findings include loss of contrast enhancement indicating fungal angioinvasion and tissue ischemia.
• Fungal spread occurs along blood vessels or nerves, leading to devastating neurological and orbital complications.

Conclusions:

• Familiarity with IFRS imaging spectrum, including extrasinus involvement, is essential for prompt diagnosis and management.
• Imaging plays a vital role in assessing the extent of IFRS and guiding treatment, particularly in immunocompromised patients.
• Understanding the anatomical pathways of fungal spread is crucial for recognizing and managing IFRS complications.