[Radiologic diagnosis of the orbit and anterior cranial fossa]

Basing on frequent diseases associated with typical changes of the orbita and the anterior cranial fossa - osteomas, fibrous dysplasia, meningiomas of the sphenoid bone, neurofibromatosis, mucoceles and pyoceles, dermoid tumours, malignant tumours and transmitted inflammatory processes - the x-ray diagnostic procedure is explained. Plain x-ray films and computed tomography are the most important methods, whereas examinations employing film tomography and angiography are now restricted to a few selected cases only.

Rhinocerebral mucormycosis with CT scan findings: a case report

A case of rhinocerebral mucormycosis in a diabetic patient is presented. The radiologic findings of the disease with differential diagnosis are reviewed. Almost complete cure with surgical excision and Amphotericin B was accomplished.

Nonsurgical cure of pulmonary mucormycosis

Pulmonary mucormycosis is an unusual infection which appears to occur with increased frequency in diabetics. We report the development of pulmonary mucormycosis in an adult onset diabetic which resolved with medical therapy alone. Computerized tomography proved useful in assessing his response to therapy.

Computed tomography of rhinocerebral mucormycosis

Rhinocerebral mucormycosis is a rare fungal infection which is frequently fatal. Survival depends on early diagnosis and immediate aggressive treatment. Previously described radiological changes have been non-specific. The CT features of two cases are described. Non-enhancement of the superior ophthalmic vein and ophthalmic artery appears to be a CT sign specific to this disease.

Cerebral mucormycosis (Phycomycosis) in a heroin addict

Cerebral mucormycosis was found at autopsy in a 27-year-old male narcotic addict with rapidly progressive focal neurologic signs. There was no evidence of rhinocerebral involvement of systemic illness, and a nuclide brain scan suggested brain abscess.

Mucormycosis: oral and prosthodontic implications. A report of 14 patients

This report includes 14 patients with rhinocerebral mucormycosis treated at the UCLA Medical Center since 1970. This disease has an extremely high mortality and morbidity. It is of interest to dentists because of the common presenting symptoms of periorbital cellulitis and sinusitis and the occasional presenting symptoms of dental pain or subperiosteal swelling. It is of further interest because of the intraoral and extraoral midfacial defects that result from disease extension and the necessary surgical débridement. The resultant facial and oral defects are far more difficult to restore than similar defects secondary to resection of head and neck neoplasms.

The computed tomographic spectrum of intracranial mycosis: correlation with histopathology

Four cases of intracerebral fungal infection are reviewed. The clinical course is outlined, and the computed tomographic (CT) characteristics are analyzed in light of known pathological data. The CT appearance of intracranial mycosis is dependent on the type of fungus as well as the dominant infecting form, i.e., yeast or hyphae. The hyphal form leads predominantly to a CT pattern consistent with vascular occlusion and secondary abscess formation; the yeast form generally results in noncaseating granulomas, which appear on CT scan as nodular enhancing lesions. If the patient survives the acute infective process, these fungal lesions undergo a prolonged subacute phase, and may eventually calcify.

Case report. Nasopharyngeal mucormycosis

Successful management of nasopharyngeal mucormycosis in a 58-year-old leukemia patient is reported. High index of suspicion, localizing the disease to the nasopharynx, early diagnosis by biopsy, control of underlying debilitating leukemia, and aggressive therapeutic approach all contributed to the successful outcome. Review of the literature indicates this to be the first reported case of successful outcome of mucormycosis in a patient with acute myelogenous leukemia. Application and findings of computed tomography for evaluation of mucormycosis are discussed.

CT scanning in rhinocerebral mucormycosis and aspergillosis

Patients with rhinocerebral mucormycosis and rhinocerebral aspergillosis had computed tomography (CT) as well as other studies. Characteristic sinus involvement was demonstrated by CT and conventional tomography, but the latter produced a better image of bone destruction. CT was clearly superior in demonstrating orbital involvement, the most common of which included lateral displacement of a thickened medial rectus muscle, increased density of the orbital apex, and often enlargement of the optic nerve. Orbital venography and carotid arteriography were diagnostically helpful. Recognition of the characteristic pattern of sinus and orbital involvement should be helpful in leading to early biopsy and treatment.

Aspergillosis and mucormycosis: two types of opportunistic fungal pneumonia

A temporal sequence of characteristic radiographic abnormalities in aspergillosis and mucormysis, two types of opportunistic pneumonia, is presented. The first manifestation is a rounded pneumonia with irregular margins, which slowly increases in size and sometimes in number. Progression to hemorrhagic pulmonary infarction is common. Nonspecific diffuse pneumonia may develop. Hematogenous dissemination to the lungs from a distant source produces a miliary-nodular pattern. In an immunocompromised patient, this sequence of findings should lead to either appropriate diagnostic procedures or empirical institution of antifungal therapy.

The pulmonary aspergilloses: three distinct entities or a spectrum of disease

The fungus Aspergillus can cause any of three clinical presentations--invasive aspergillosis, mycetoma, or allergic bronchopulmonary aspergillosis--or a disease process in which one of these entities overlaps with another process such as mucoid impaction, eosinophilic pneumonia, bronchocentric granulomatosis, "farmer's lung," or asthma. More than one form of the disease may be present at the same time; in addition, limited invasion may occur even in "noninvasive" forms of the disease, and the clinical and pathological aspects of allergic aspergillosis are often indistinguishable from those of unrelated allergic conditions. Thus it is no longer possible to compartmentalize the various types of pulmonary aspergillosis into exclusive forms of the disease; rather, the radiologist should be aware that various factors can modify the mode of growth of the fungus as well as the patient's response.

Craniofacial mucormycosis: computed tomographic and angiographic findings in two cases

Two cases of craniofacial mucormycosis are presented, stressing computed tomographic (CT) and angiographic findings. In the first case, successful embolization of a sphenopalatine artery pseudoaneurysm is shown. The second case demonstrates CT findings of ethmoidal sinus and frontal lobe inflammatory change. Ophthalmic artery occlusion is show. Obstructive venous changes within the orbit and cavernous sinus are displayed by means of orbital venography.

CT approach to benign nasopharyngeal masses

The physical characteristics of the fascial planes of the nasopharynx provide a basis for categorizing growth patterns of the more common benign nasopharyngeal masses. Lymphoid hyperplasias are confined to the surface by the very dense pharyngobasilar fascia that lies beneath the submucosa. It takes a very aggressive process to cross this fascial plane. More laterally throughout the paranasopharyngeal space the loose areolar nature of the buccopharyngeal fascia permits benign tumors in this space to assume a spherical configuration. The carotid sheath is also a loose areolar arrangement that permits free movement of the carotid artery in the neck. Juvenile angiofibromas permeate natural foramina, displace bony septa, and extend widely but do not invade the carotid sheath. Neurogenic tumors and paragangliomas are intimately associated with contents of the carotid sheath; therefore, they obliterate the low density regions surrounding the carotid vessels.

Patient survival factors in paranasal sinus mucormycosis

Analysis of 170 cases of paranasal sinus mucormycosis collected from the literature and 9 cases of our own revealed a 50% mortality for this disease. When analyzed according to decade, survival has increased to 70% in the cases reported from 1970-1979. There were no significant differences between the survivors and the fatalities when evaluated according to age, sex, laterality, or radiographic findings. There was a markedly poorer prognosis for those patients with hemiplegia, facial necrosis, and nasal deformity. The underlying disease was an important determinant of survival: 75% of patients with no systemic disease, 60% of diabetics, and 20% of patients with other disorders survived. Surgical debridement or radical resection and the use of amphotericin B significantly increased survival. Their combination further enhanced survival, especially in the diabetic.

Gastrointestinal mucormycosis

Mucormycosis is an acutely malignant fungal disease causing local thrombosis and infarction. Gastrointestinal infection most commonly occurs in diabetics or in the immunologically compromised. This case demonstrates the radiological appearances of the gastrointestinal lesion and prolonged survival with amphotericin-B therapy.

Treatment of localized pulmonary phycomycosis

A patient cured of localized pulmonary phycomycosis occurring at the site of a previous lung abscess is described and the other survivors of this unusual entity are discussed. Whole-lung computerized tomographic (CT) scanning was useful in confirming the presence of a single localized lesion and led to the choice of surgical excision. A diagnostic and therapeutic approach including whole-lung CT scanning and preoperative and postoperative systemic amphotericin B therapy is suggested pending pathologic review of the tissues for possible fungal invasion beyond the resected area. The value of surgical excision when the disease appears localized is emphasized.

Vertebral osteomyelitis and epidural abcess due to mucormycosis, a case report

A patient is described, with a history of pain in the neck, followed by a slowly progressive loss of muscle strength in both arms, followed by tetraplegia. Medical history included laryngectomy with partial hypopharyngectomy preceded by radiotherapy, because of carcinoma. X-ray of the cervical spine was suggestive for metastases. The patient died as a consequence of massive pulmonary embolism and at autopsy the cause of the neurological deficit turned out to be vertebral osteomyelitis and epidural abscess due to mucormycosis.

Cerebral mucormycosis--a case report

A case of cerebral fungal granuloma with histological evidence of vasculitis is reported and the literature briefly reviewed. The value of surgery and chemotherapy for this entity which cured the patient without any sequelae of the disease process or chemotherapeutic agent is emphasized.