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Can imaging suggest the aetiology in skull base osteomyelitis? A systematic literature review. Pol J Radiol 2021; 86:e309-e321. [PMID: 34136049 PMCID: PMC8186306 DOI: 10.5114/pjr.2021.106470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/15/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To assess differentiating features between bacterial, Aspergillus, and Mucor skull base osteomyelitis (SBO) with regard to clinical presentation and imaging appearances. Material and methods A literature search was performed in April 2020 for studies on SBO with a minimum sample size of 10 patients. Studies that reported presenting symptoms, cross-sectional imaging findings, complications, and mortality were included in the analysis. The quality of included articles was tested using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A data extraction form was used to retrieve relevant parameters from each of the articles. Results Thirteen articles were included in the final analysis. Diabetes mellitus was the most common predisposing factor (12.5-91.0%). Presenting complaints in all bacterial SBO studies were otogenic, while fungal SBO patients had nasal/ocular complaints. Rates of mortality and surgical intervention in the fungal group were 50-100% and 50%, respectively, as compared to the bacterial group – 7-87% and 10%, respectively. On imaging, the site of initial infection in bacterial SBO was the external auditory canal, while in fungal SBO it was the paranasal sinus. The incidence of orbital extension was < 5% in bacterial and 44-70% in fungal SBO, among which Mucor had rates of 65-70%. Bone erosion was less extensive in bacterial SBO, and the patterns differed. The highest incidence of vascular involvement and non-enhancing lesions (23-36%) was seen in Mucor. Aspergillus showed highest sino-cranial extension (52-55%) and homogenous bright enhancement. Conclusions Systematic analysis of the clinico-radiological parameters in each of the studies revealed differences in presentation, clinical course, extension, bone erosion, and enhancement.
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Manjunath KS, Shivaswamy S, Kulkarni JD, Kenkare Venkatachalaiah R. Rhino-orbito-cerebral mucormycosis (ROCM) with internal carotid artery stenosis in a diabetic patient with caries tooth and oroantral fistula. BJR Case Rep 2016; 2:20150447. [PMID: 30363653 PMCID: PMC6180894 DOI: 10.1259/bjrcr.20150447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/12/2015] [Accepted: 01/03/2016] [Indexed: 11/15/2022] Open
Abstract
Mucormycosis is a rare, potentially fatal and opportunistic infection caused by fungi belonging to the order Mucorales. Rhinocerebral, gastrointestinal, pulmonary, cutaneous and disseminated are the different forms of mucormycosis. Rhinocerebral mucormycosis is the most common type and presents as a highly destructive infection in immunocompromised hosts, especially in patients with poorly controlled diabetes. The infection originates in the nasal mucosa owing to fungal inoculation and then spreads to the paranasal sinuses, orbits, orbital apex, cavernous sinuses and brain. Our patient was a 36-year-old female with poorly controlled diabetes who presented with orbital symptoms and signs, with very subtle involvement of the sinuses. She had stenosis of the entire left internal carotid artery, with multiple small infarcts in the left frontal and parietal lobes. She incidentally had tooth caries tooth with a periapical cyst and an oroantral fistula. Ours was a histopathologically proven case of rhino-orbito-cerebral mucormycosis.
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Affiliation(s)
| | - Santosh Shivaswamy
- Department of Otorhinolaryngology, Columbia Asia Hospital, Bangalore, India
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Middlebrooks EH, Frost CJ, De Jesus RO, Massini TC, Schmalfuss IM, Mancuso AA. Acute Invasive Fungal Rhinosinusitis: A Comprehensive Update of CT Findings and Design of an Effective Diagnostic Imaging Model. AJNR Am J Neuroradiol 2015; 36:1529-35. [PMID: 25882281 DOI: 10.3174/ajnr.a4298] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 01/15/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Acute invasive fungal rhinosinusitis carries a high mortality rate. An easy-to-use and accurate predictive imaging model is currently lacking. We assessed the performance of various CT findings for the identification of acute invasive fungal rhinosinusitis and synthesized a simple and robust diagnostic model to serve as an easily applicable screening tool for at-risk patients. MATERIALS AND METHODS Two blinded neuroradiologists retrospectively graded 23 prespecified imaging abnormalities in the craniofacial region on craniofacial CT examinations from 42 patients with pathology-proven acute invasive fungal rhinosinusitis and 42 control patients proved negative for acute invasive fungal rhinosinusitis from the same high-risk population. A third blinded neuroradiologist decided discrepancies. Specificity, sensitivity, positive predictive value, and negative predictive value were determined for all individual variables. The 23 variables were evaluated for intercorrelations and univariate correlations and were interrogated by using stepwise linear regression. RESULTS Given the low predictive value of any individual variable, a 7-variable model (periantral fat, bone dehiscence, orbital invasion, septal ulceration, pterygopalatine fossa, nasolacrimal duct, and lacrimal sac) was synthesized on the basis of multivariate analysis. The presence of abnormality involving a single variable in the model has an 87% positive predictive value, 95% negative predictive value, 95% sensitivity, and 86% specificity (R(2) = 0.661). A positive outcome in any 2 of the model variables predicted acute invasive fungal rhinosinusitis with 100% specificity and 100% positive predictive value. CONCLUSIONS Our 7-variable CT-based model provides an easily applicable and robust screening tool to triage patients at risk for acute invasive fungal rhinosinusitis into a disease-positive or -negative category with a high degree of confidence.
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Affiliation(s)
- E H Middlebrooks
- From the Department of Radiology (E.H.M., R.O.D.J., T.C.M., I.M.S., A.A.M.), University of Florida College of Medicine, Gainesville, Florida
| | - C J Frost
- Medical Imaging Consultants, Inc (C.J.F.), Gainesville, Florida
| | - R O De Jesus
- From the Department of Radiology (E.H.M., R.O.D.J., T.C.M., I.M.S., A.A.M.), University of Florida College of Medicine, Gainesville, Florida
| | - T C Massini
- From the Department of Radiology (E.H.M., R.O.D.J., T.C.M., I.M.S., A.A.M.), University of Florida College of Medicine, Gainesville, Florida North Florida/South Georgia Veterans Administration (T.C.M., I.M.S.), Gainesville, Florida
| | - I M Schmalfuss
- From the Department of Radiology (E.H.M., R.O.D.J., T.C.M., I.M.S., A.A.M.), University of Florida College of Medicine, Gainesville, Florida North Florida/South Georgia Veterans Administration (T.C.M., I.M.S.), Gainesville, Florida
| | - A A Mancuso
- From the Department of Radiology (E.H.M., R.O.D.J., T.C.M., I.M.S., A.A.M.), University of Florida College of Medicine, Gainesville, Florida
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Cornely O, Arikan-Akdagli S, Dannaoui E, Groll A, Lagrou K, Chakrabarti A, Lanternier F, Pagano L, Skiada A, Akova M, Arendrup M, Boekhout T, Chowdhary A, Cuenca-Estrella M, Freiberger T, Guinea J, Guarro J, de Hoog S, Hope W, Johnson E, Kathuria S, Lackner M, Lass-Flörl C, Lortholary O, Meis J, Meletiadis J, Muñoz P, Richardson M, Roilides E, Tortorano A, Ullmann A, van Diepeningen A, Verweij P, Petrikkos G. ESCMID† and ECMM‡ joint clinical guidelines for the diagnosis and management of mucormycosis 2013. Clin Microbiol Infect 2014; 20 Suppl 3:5-26. [DOI: 10.1111/1469-0691.12371] [Citation(s) in RCA: 465] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 08/09/2013] [Accepted: 08/12/2013] [Indexed: 12/22/2022]
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5
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Leyngold I, Olivi A, Ishii M, Blitz A, Burger P, Subramanian PS, Gallia G. Acute chiasmal abscess resulting from perineural extension of invasive sino-orbital aspergillosis in an immunocompetent patient. World Neurosurg 2013; 81:203.e1-6. [PMID: 23973515 DOI: 10.1016/j.wneu.2013.08.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 05/30/2013] [Accepted: 08/14/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Intracranially invasive sino-orbital aspergillosis is a rare entity seen predominantly in immunocompromised individuals. We report a unique case of an acute chiasmal abscess resulting from perineural extension of an indolent invasive sino-orbital aspergillosis in an immunocompetent patient. CASE DESCRIPTION A 61-year-old healthy Ukrainian man presented with severe left retro-orbital pain and a gradual ipsilateral monocular vision loss with rapid progression to a contralateral temporal visual field cut. He was found to have an intracranially invasive sino-orbital Aspergillus fumigatus infection with perineural extension along the optic nerve complicated by an acute chiasmal abscess. RESULTS The patient was managed with surgical debridement and adjuvant antifungal chemotherapy. The patient's life and vision were preserved. CONCLUSIONS The case demonstrates that it is possible to successfully control advanced intracranial aspergillosis with tissue-sparing surgery and adjuvant antifungal chemotherapy in immunocompetent individuals.
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Affiliation(s)
- Ilya Leyngold
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Alessandro Olivi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Masaru Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ari Blitz
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter Burger
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Prem S Subramanian
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gary Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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6
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Clinical and Radiologic Features of Fungal Diseases of the Paranasal Sinuses. J Comput Assist Tomogr 2012; 36:570-6. [DOI: 10.1097/rct.0b013e318263148c] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Rhinocerebral mucormycosis: experience in 14 patients. The Journal of Laryngology & Otology 2011; 125:e3. [DOI: 10.1017/s0022215111000843] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractObjective:Mucormycosis is an opportunist, often lethal fungal infection which occurs in immunocompromised patients. We present our experience in 14 patients with this condition.Patients and methods:A retrospective chart review was conducted for 14 patients treated for rhinocerebral mucormycosis.Results:Nine patients had diabetes mellitus and six had a haematological malignancy. Nine patients had cutaneous and/or palatal necrosis. Eleven patients were treated with amphotericin B and five with liposomal amphotericin B. Endoscopic sinus surgery was performed in five patients with disease limited to the sinonasal cavity; nine patients underwent more extensive surgery. Five patients with disease limited to the sinonasal cavity survived, while nine patients with widely disseminated disease died. Five of the nine diabetic patients died, as did five of the six patients with haematological malignancy.Conclusion:Patients with rhinocerebral mucormycosis spreading outside the sinonasal cavity have a poor prognosis.
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Singh V, Sharma B, Sen R, Agrawal S, Dhingra R. Abnormal growth of the maxillary sinus and orbit. J Oral Maxillofac Surg 2011; 69:2167-72. [PMID: 21367500 DOI: 10.1016/j.joms.2010.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 10/15/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Virendra Singh
- Department of Oral and Maxillofacial Surgery, Government Dental College, Pt. B.D. Sharma University of Medical Sciences, Rohtak, India.
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Vaid S, Vaid N, Rawat S, Ahuja AT. An imaging checklist for pre-FESS CT: framing a surgically relevant report. Clin Radiol 2011; 66:459-70. [PMID: 21288796 DOI: 10.1016/j.crad.2010.11.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 11/14/2010] [Accepted: 11/16/2010] [Indexed: 11/24/2022]
Abstract
The reference standard for preoperative imaging in functional endoscopic sinus surgery (FESS) is multiplanar high-resolution computed tomography (HRCT). Surgeons require a precise preoperative anatomical road map, and hence it is essential for radiologists to be familiar with the normal three-dimensional sinonasal anatomy and the normal variants encountered in this region. Sagittal imaging has recently emerged as an important tool to visualize additional details in this critical anatomical region. Radiologists also need to report these examinations with special focus on the surgeon's expectations. Constant communication between the radiologist and the surgeon helps to resolve specific issues and improve the overall quality of reports. This results in better preoperative patient counselling and in predicting postoperative improvement in clinical status. This review provides a basic structured format for reporting pre-FESS CT, which can be tailored to meet individual requirements. The CT reporting format follows the order in which the sinonasal structures are approached during surgery.
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Affiliation(s)
- S Vaid
- Department of Radiology and Imaging, Grant Medical Foundation, Pune, India.
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10
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Zygomycotic invasion of the central nervous system. Jpn J Radiol 2010; 28:376-80. [DOI: 10.1007/s11604-010-0435-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 03/03/2010] [Indexed: 10/19/2022]
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11
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Lee EJ, Chung JW, Choi S, Kim YS, Woo JH. [Forefront of diagnosis and treatment of deep-steam mycology in Korea--rhinoorbitocerebral zygomycosis]. ACTA ACUST UNITED AC 2010; 50:229-33. [PMID: 19942794 DOI: 10.3314/jjmm.50.229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mucor is a mold which exists in nature, but mucor infections of humans, even in immunocompromised hosts, are rare. Clinical manifestations of mucormycosis are nonspecific and diagnosis is based on microscopic examination and culture of biopsy specimens. Serologic test or molecular methods of speciation are used only as research tools. We investigated medical records especially for underlying diseases, clinical findings, treatment, and prognosis of patients diagnosed with rhinocerebral mucormycosis retrospectively in the Asan Medical Center. The underlying diseases were diabetes mellitus in 8 patients, acute leukemia in 2, kidney transplantation in 2, and myelodysplastic syndrome in 1 of the total 13 patients. Six patients complained of nasal symptoms including stuffy nose, rhinorrhea, 5 patients complained of ophthalmic symptoms such as decreased visual acuity, diplopia, and ophthalmic pain and 2 of hard palate ulcer. The mortality was 23%(3/13; the two patients with kidney transplant, and one patient with acute leukemia). In summary, mucormycosis should be considered in an uncontrolled DM and an immunocompromised host. The combined modality of early surgical debridement and antifungal agents was used for better treatment of rhinocerebral mucormycosis.
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Affiliation(s)
- Eun Jung Lee
- Department of Infectious Diseases, University of Ulsan College of Medicine, Asan Medical Center
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12
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Elinav H, Zimhony O, Cohen MJ, Marcovich AL, Benenson S. Rhinocerebral mucormycosis in patients without predisposing medical conditions: a review of the literature. Clin Microbiol Infect 2009; 15:693-7. [PMID: 19624514 DOI: 10.1111/j.1469-0691.2009.02884.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Rhinocerebral mucormycosis is a rare disease, affecting almost exclusively patients with known predisposing conditions such as diabetes mellitus, immunocompromised status, haemochromatosis or major trauma. Subsequent to a case of rhinocerebral mucormycosis in a 78-year-old woman without any known risk factor, we reviewed the published English-language literature and found an additional 72 cases. Reviewing all the published case series of mucormycosis involving any site, the proportion of apparently normal hosts among cases of rhinocerebral mucormycosis was found to be 9.06% (95% confidence interval 6.7-11.8). These findings suggest that rhinocerebral mucormycosis in patients without known predisposing factors is more prevalent than was previously believed.
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Affiliation(s)
- H Elinav
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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13
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Bradley SF, McGuire NM, Kauffman CA. Sino-Orbital and Cerebral Aspergillosis: Cure with Medical Therapy/Sino-Orbital- und Zerebralaspergillose: Ausheilung durch medikamentöse Therapie. Mycoses 2009. [DOI: 10.1111/j.1439-0507.1987.tb03632.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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O'Neill BM, Alessi AS, George EB, Piro J. Disseminated rhinocerebral mucormycosis: a case report and review of the literature. J Oral Maxillofac Surg 2006; 64:326-33. [PMID: 16413907 DOI: 10.1016/j.joms.2005.10.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2004] [Indexed: 10/25/2022]
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15
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Sinusitis, Periorbital Edema, and Ocular Proptosis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2005. [DOI: 10.1097/01.idc.0000179877.90431.a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Siddiqui AA, Shah AA, Bashir SH. Craniocerebral Aspergillosis of Sinonasal Origin in Immunocompetent Patients: Clinical Spectrum and Outcome in 25 Cases. Neurosurgery 2004; 55:602-11; discussion 611-3. [PMID: 15335427 DOI: 10.1227/01.neu.0000134597.94269.48] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2003] [Accepted: 05/06/2004] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE:
Craniocerebral aspergillosis of sinonasal origin has been reported mainly in immunocompromised patients with high mortality, and it has been described very infrequently in immunocompetent hosts. This retrospective study focuses on clinical outcome in relation to anatomic locations of invasive aspergillosis of sinonasal origin in immunocompetent patients with emphasis on our preliminary experience with use of preoperative orally administered itraconazole.
METHODS:
Medical records of patients treated in two tertiary care hospitals from 1991 to 2003 were reviewed retrospectively. All patients had radiological evidence of disease in the paranasal sinuses with or without intracranial extension. The study cohort was divided into three types on the basis of area of involvement revealed by computed tomographic or magnetic resonance imaging scans of brain. All patients underwent surgical intervention and treatment with antifungal therapy. Preoperative orally administered itraconazole therapy was used in four patients on the basis of neuroradiological features. Clinical outcome was assessed with the Glasgow Outcome Scale, and univariate analysis of prognostic factors was performed with 95% confidence interval (P = 0.05).
RESULTS:
Mean patient age was 36.5 years (range, 14–74 yr) with a male preponderance (male-to-female ratio, 23:2). Nasal stuffiness (n = 13), headaches (n = 10), proptosis (n = 9), and nasal discharges (n = 7) were major presenting clinical features. Radiological data were obtained by computed tomographic (n = 25) and magnetic resonance imaging (n = 20) scans of the brain, and diagnoses were established by histopathological analysis (n = 20) or/and fungal cultures (n = 15). Preoperative orally administered itraconazole was given in four patients with intracerebral aspergillosis. Overall mortality was 28% and was highest in patients with Type 1 aspergillosis (66.7%). Type 3 aspergillosis and use of preoperative itraconazole remained statistically significant prognostic factors.
CONCLUSION:
Craniocerebral aspergillosis in immunocompetent hosts has three patterns of presentation that seem to correlate with clinical outcomes. Intracerebral aspergillosis (Type 1) is associated with the worst clinical outcome. Patients with orbital and cranial base aspergillosis (Type 3) had good recovery. Intracranial extradural aspergillosis (Type 2) remained intermediate on the Glasgow Outcome Scale. Preoperative orally administered itraconazole therapy may improve clinical outcome in patients with intracerebral aspergillosis. Prospective clinical studies are required to make firm clinical therapeutic recommendations.
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Schoenborn WC, Wisner ER, Kass PP, Dale M. Retrospective assessment of computed tomographic imaging of feline sinonasal disease in 62 cats. Vet Radiol Ultrasound 2003; 44:185-95. [PMID: 12718354 DOI: 10.1111/j.1740-8261.2003.tb01269.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Sixty-two cats with sinonasal disease were evaluated with computed tomography. Findings that may lead to a computed tomographic diagnosis of nasal neoplasia versus rhinitis included osteolysis of the paranasal bones, moderate to severe turbinate destruction, lysis of the nasal septum, the presence of a homogenous space occupying mass, and extension of the disease process into the orbit or facial soft tissues. These findings were not pathognomonic for neoplasia and may be associated with severe rhinitis; therefore, nasal biopsy was recommended. When compared with parallel radiographic studies, computed tomography was not more sensitive than radiographs at detecting the presence of nasal cavity abnormalities in cats with referable clinical signs but was more sensitive at localizing these changes and determining the extent of disease.
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Affiliation(s)
- William C Schoenborn
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
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18
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Saah D, Sichel JY, Schwartz A, Nagler A, Eliashar R. CT assessment of bone marrow transplant patients with rhinocerebral aspergillosis. Am J Otolaryngol 2002; 23:328-31. [PMID: 12430122 DOI: 10.1053/ajot.2002.128040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Invasive rhinocerebral aspergillosis is a hazardous complication of bone marrow transplantation. A study was conducted to describe the computed tomography (CT) features of this disease. MATERIALS AND METHODS Charts and CT scans of bone marrow transplant patients with invasive rhinocerebral aspergillosis were reviewed. The diagnosis was confirmed by otolaryngologic examination and biopsy of suspected lesions. Sinus CT scans were conducted without contrast material. They were repeated with contrast if intracranial or intraorbital extension was suspected. CT scans were correlated with physical examination, history of disease, and histology. RESULTS Of 1,013 bone marrow transplantations carried out over a 10-year period, 21 patients (2.07%) developed invasive rhinocerebral aspergillosis. In most cases the infection was unilateral. Air-fluid levels and calcifications were rarely encountered. Mucosal thickening, soft tissue hyperdense masses in the nasal cavity and/or sinuses, and clear (uninvolved) ethmoid cells amid diseased cells, were significant CT features that characterized invasive fungal infection. Opacification of the sinus represented extensive disease with tissue necrosis. When bone destruction was encountered, fulminant infection was already present, usually with significant orbital and/or brain invasion. CONCLUSIONS When correlated with clinical findings and histologic results, the above CT features can help identify early infection so that appropriate medical and surgical treatment can be instituted.
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Affiliation(s)
- Daniel Saah
- Departments of Otolaryngology/Head & Neck Surgery, Hadassah University Hospital, Jerusalem, Israel
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19
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Talmi YP, Goldschmied-Reouven A, Bakon M, Barshack I, Wolf M, Horowitz Z, Berkowicz M, Keller N, Kronenberg J. Rhino-orbital and rhino-orbito-cerebral mucormycosis. Otolaryngol Head Neck Surg 2002; 127:22-31. [PMID: 12161726 DOI: 10.1067/mhn.2002.126587] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Rhino-orbito-cerebral mucormycosis (ROCM) is a devastating infection of immunocompromised hosts. We present our experience with 19 ROCM cases and attempt to define preferred diagnostic and treatment protocols. METHODS All had tissue biopsies obtained studied by direct smear, histologic studies, and cultures. Imaging was obtained in 14 cases. RESULTS Sixteen patients presented between August and November. Six had mixed fungal infections. Seven patients had end-stage underlying disease or infection and did not undergo surgery and 4 had an indolent form of disease. Patients were treated by surgery and by amphotericin B. The overall survival was 47%. CONCLUSIONS ROCM may have seasonal incidence peaking in the fall and early winter. The therapeutic approach should be unchanged in cases of mixed fungal infections. Amphotericin B with aggressive debridement remains the mainstay of treatment. Early recognition and treatment are essential. A presentation and survival-dependent classification of ROCM are offered.
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Affiliation(s)
- Yoav P Talmi
- Departments of Otolaryngology-Head and Neck Surgery, The Chaim Sheba Medical Center, Israel.
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20
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Mondy KE, Haughey B, Custer PL, Wippold FJ, Ritchie DJ, Mundy LM. Rhinocerebral mucormycosis in the era of lipid-based amphotericin B: case report and literature review. Pharmacotherapy 2002; 22:519-26. [PMID: 11939688 DOI: 10.1592/phco.22.7.519.33679] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Rhinocerebral mucormycosis (RCM) is an invasive fungal infection that necessitates, in most cases, aggressive surgical debridement and high cumulative, often nephrotoxic doses of amphotericin B. A 50-year-old woman with RCM was treated successfully with amphotericin B lipid complex as primary therapy. The patient previously had displayed progressive intracranial involvement and rising serum creatinine levels while receiving the conventional (nonlipid) form of amphotericin B. A literature review identified only a few cases where systemic antifungal therapy was administered, with minimal or no surgery. Our case further supports that amphotericin B lipid complex can be used as primary therapy in selected patients with RCM, without the need for surgical exenteration.
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Affiliation(s)
- Kristin E Mondy
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri 63110, USA
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Saunders JH, Zonderland JL, Clercx C, Gielen I, Snaps FR, Sullivan M, vanBree H, Dondelinger RF. Computed tomographic findings in 35 dogs with nasal aspergillosis. Vet Radiol Ultrasound 2002; 43:5-9. [PMID: 11866045 DOI: 10.1111/j.1740-8261.2002.tb00434.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study was to describe the computed tomographic (CT) features of nasal aspergillosis in dogs. Initial (n = 35) and follow-up (n = 12) CT images were available from 35 dogs. The most commonly encountered CT findings were (1) moderate to severe cavitary destruction of the turbinates with presence of a variable amount of abnormal soft tissue in the nasal passages, (2) non-specific thickening of the mucosa adjacent to the inner surface of bones of the frontal sinus, maxillary recess and nasal cavity and, (3) thickened reactive bone. The findings were consistent with a disease initially affecting one nasal cavity then progressing into the ipsilateral frontal sinus, the contralateral nasal cavity and the contralateral frontal sinus. Two dogs with associated nasal foreign body had a more localized invasion of the nasal cavity. Attenuation values and contrast enhancement were not specific. With follow-up examinations, a reduction in the amount of abnormal soft tissue was observed in all dogs except one, but this reduction could not be quantified.
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Affiliation(s)
- Jimmy H Saunders
- Department of Medical Imaging, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
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22
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Rizk SS, Kraus DH, Gerresheim G, Mudan S. Aggressive Combination Treatment for Invasive Fungal Sinusitis in Immunocompromised Patients. EAR, NOSE & THROAT JOURNAL 2000. [DOI: 10.1177/014556130007900414] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Invasive sinonasal fungal disease is a potentially fatal complication of chemotherapy-induced immunosuppression and neutropenia. We reviewed the outcomes of seven cancer patients who had been diagnosed with invasive fungal sinusitis; six patients had hematologic malignancies and one had breast cancer. At the time of their sinus diagnosis, all patients had been hospitalized and were receiving combination chemotherapy for their underlying malignancy. Impairment of their immune function was characterized by an absolute neutrophil count of less than 1,000/mm3. Aggressive management of their sinonasal fungal disease consisted of surgical debridement and systemic amphotericin B for all patients, and treatment with granulocyte colony-stimulating factor for two patients. Invasive Aspergillus infection was identified in six patients and invasive Candida albicans infection in one. Although the prognosis for these patients was poor and two patients died of the fungal infection, the aggressive treatment strategy resulted in long-term survival for the remaining five patients.
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Affiliation(s)
- Samieh S. Rizk
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, New York City
| | - Dennis H. Kraus
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, New York City
| | - Goetz Gerresheim
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, New York City
| | - Satvinder Mudan
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, New York City
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23
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Ooi GC, Chim CS, Liang R, Tsang KW, Kwong YL. Nasal T-cell/natural killer cell lymphoma: CT and MR imaging features of a new clinicopathologic entity. AJR Am J Roentgenol 2000; 174:1141-5. [PMID: 10749267 DOI: 10.2214/ajr.174.4.1741141] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Nasal T-cell/natural killer cell lymphoma is a new clinicopathologic entity with a characteristic immunophenotypic profile and distinct clinical features. This study describes the radiologic features of nine cases of proven nasal T-cell/natural killer cell lymphoma. CONCLUSION Nasal T-cell/natural killer cell lymphoma is often a locally destructive (T stages 3 and 4) disease, typically presenting with obliteration of the nasal passages and maxillary sinuses. Involvement of the adjacent alveolar bone, hard palate, orbits, and nasopharynx is found in more than 50% of cases and is associated with extensive soft-tissue masses. Presence of bone erosion is suggestive but not diagnostic of the disease.
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Affiliation(s)
- G C Ooi
- Department of Diagnostic Radiology, The University of Hong Kong, Queen Mary Hospital, Pokfulam, China
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24
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Fatterpekar G, Mukherji S, Arbealez A, Maheshwari S, Castillo M. Fungal diseases of the paranasal sinuses. Semin Ultrasound CT MR 1999; 20:391-401. [PMID: 10634589 DOI: 10.1016/s0887-2171(99)90023-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Fungal diseases of the paranasal sinuses can be categorized into the invasive and noninvasive varieties. The invasive form has been classified as acute fulminant fungal sinusitis, granulomatous invasive fungal sinusitis, and chronic invasive fungal sinusitis. The noninvasive form can be classified as the fungus ball and the allergic fungal sinusitis. The following review discusses the various types of fungal sinusitis with a special emphasis on the CT and MR imaging features.
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Affiliation(s)
- G Fatterpekar
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill 27599-7510, USA
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25
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 22-1999. A 68-year-old woman with multiple myeloma, diabetes mellitus, and an inflamed eye. N Engl J Med 1999; 341:265-73. [PMID: 10413740 DOI: 10.1056/nejm199907223410408] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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26
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Hendrickson RG, Olshaker J, Duckett O. Rhinocerebral mucormycosis: a case of a rare, but deadly disease. J Emerg Med 1999; 17:641-5. [PMID: 10431954 DOI: 10.1016/s0736-4679(99)00053-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Rhinocerebral mucormycosis is a rare fungal infection of the nasal cavity and sinuses that can spread to the orbits and cranium within days. Its presentation can be confused with those of sinusitis, viral infections, diabetic ketoacidosis, or carotid sinus thrombosis, and it is often missed at early presentation. Survival is directly linked to early detection and treatment. We present a case of rhinocerebral mucormycosis and discuss the literature on its early signs and symptoms, pathophysiology, and treatment options.
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Affiliation(s)
- R G Hendrickson
- Department of Emergency Medicine, Medical College of Pennsylvania/Hahnemann University, Philadelphia 19129, USA
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27
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Jiang RS, Hsu CY. Endoscopic sinus surgery for rhinocerebral mucormycosis. AMERICAN JOURNAL OF RHINOLOGY 1999; 13:105-9. [PMID: 10219438 DOI: 10.2500/105065899782106751] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Rhinocerebral mucormycosis is a fulminant, often fatal, disease. Aggressive surgical debridement has been considered an important part of treatment. Traditionally, an external or transantral approach has been the classic method. Recently, endoscopic sinus surgery (ESS) has been tried on several occasions to reach the goal of radical resection. Since 1991, ESS has been used to treat 9 rhinocerebral mucormycosis patients in our department. Among them, ESS was the only surgical procedure in six patients. The other three patients were treated by ESS combined with a transantral procedure. As a result, eight patients (88.9%) have survived the disease. One patient died 5 days after ESS because of an internal carotid artery occlusion. We conclude that ESS can be used to treat rhinocerebral mucormycosis alone or in combination with the traditional surgical procedures. It has the advantage of less operative morbidity and greater operative accuracy.
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Affiliation(s)
- R S Jiang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taiwan, Republic of China
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28
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Berry JA, Davidson TM. Radiology of Unilateral Sinonasal Opacification. EAR, NOSE & THROAT JOURNAL 1999. [DOI: 10.1177/014556139907800108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Two recent cases managed at the University of California San Diego (UCSD) Nasal Dysfunction Clinic are described, with a review of the sinus computed tomography (CT) findings of six common unilateral sinonasal conditions. These include the homogeneous appearance and absence of bony destruction characteristic of unilateral benign polyposis, the focal hyperintensities of fungal sinusitis, the septal bowing seen in inverting papilloma, the involvement of the pterygopalatine fossa by an angiofibroma, the cribiform plate dehiscence associated with an encephalocele/meningocele and the extensive bony destruction characteristic of malignancy, such as epidermoid carcinoma. The clinical appearance and salient sinus CT features may suggest the diagnosis, thereby decreasing the morbidity from invasive tests, such as biopsy of an angiofibroma or an encephalocele, and improving quality resource management.
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Affiliation(s)
- Julie A. Berry
- Otolaryngology-Head and Neck Surgery Resident, University of Maryland, Baltimore, San Diego, California
| | - Terence M. Davidson
- Professor of Surgery and Associate Dean of Continuing Medical Education, Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, and VA San Diego Healthcare System, San Diego, California
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29
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Eustis HS, Mafee MF, Walton C, Mondonca J. MR imaging and CT of orbital infections and complications in acute rhinosinusitis. Radiol Clin North Am 1998; 36:1165-83, xi. [PMID: 9884695 DOI: 10.1016/s0033-8389(05)70238-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The acute onset of orbital and periorbital inflammation presents the clinician with a diagnostic and therapeutic dilemma, the consequence of which may be very serious. The progression from the initial stage of cellulitis to orbital abscess, cavernous sinus thrombosis, brain abscess, meningitis, or visual loss may be quite rapid at times. CT, ultrasonography, and MR imaging play an important role in clinical management of these patients. Indeed, it is the information obtained through orbital imaging that directs the clinician to use the correct therapeutic modality.
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Affiliation(s)
- H S Eustis
- Department of Ophthalmology, Ochsner Clinic, New Orleans, Louisiana, USA
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30
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Khanna SK, Soumekh B, Bradley JS, Billman G, Kearns DB, Spear RM, Peterson BM. A case of fatal rhinocerebral mucormycosis with new onset diabetic keto-acidosis. J Diabetes Complications 1998; 12:224-7. [PMID: 9647341 DOI: 10.1016/s1056-8727(97)00078-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- S K Khanna
- Children's Hospital, San Diego, Califonia, USA
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31
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Sharma BS, Khosla VK, Kak VK, Banerjee AK, Vasishtha RK, Prasad KS, Sharma SC, Mathuriya SN, Tewari MK, Pathak A. Intracranial fungal granuloma. SURGICAL NEUROLOGY 1997; 47:489-97. [PMID: 9131036 DOI: 10.1016/s0090-3019(96)00209-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Intracranial fungal granulomas are uncommon and their pathogenesis, clinical picture, and effectiveness of therapy remains unclear. METHODS Thirty-two cases were studied retrospectively in two groups: (1) Rhinocerebral group (22 cases) had a chronic paranasal sinus (PNS) disease with secondary involvement of skull base, cranial nerves, and/or brain. The granulomas were adherent to dura, firm, avascular, and tough, requiring a knife to cut. (2) Primary intracranial group (10 cases) had no detectable PNS lesion at initial presentation. The granulomas were soft, suckable, and contained pus or necrotic material. RESULTS Postoperative and overall mortality were 37.5% and 50%, respectively. Meningoencephalitis was the most common cause of death. Altered sensorium, pus in the granuloma, and/or severe brain edema were poor prognostic factors. All survivors except four have symptomatic residual or recurrent lesions. CONCLUSION Early diagnosis with MRI or stereotactic biopsy, radical surgery, and high dose and chronic suppressive chemotherapy may improve overall results in these cases.
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Affiliation(s)
- B S Sharma
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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32
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Lenglinger FX, Krennmair G, Müller-Schelken H, Artmann W. Radiodense concretions in maxillary sinus aspergillosis: pathogenesis and the role of CT densitometry. Eur Radiol 1996; 6:375-9. [PMID: 8798009 DOI: 10.1007/bf00180617] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to investigate by CT the origin of radiodense maxillary sinus concretions and whether CT densitometry is effective in the prediction of maxillary sinus aspergillosis and in the differentiation of the origin of these concretions. In a prospective study in 21 patients with radiodense maxillary sinus concretions detected by radiography, a preoperative CT study of the paranasal sinuses and the concretions was undertaken. Additional scans of the upper alveolar ridge were also performed. Radiological findings were compared with clinical symptoms and with CT findings, especially CT densitometry of the sinus concretions and dental root-filling material. All patients underwent a functional Caldwell-Luc operation; histological and microbiological examinations were performed. Fifteen of the 21 patients (71.4%) with radiodense concretions had a histological and microbiological diagnosis of sinus aspergillosis. The sinus concretions had CT densities higher than 2000 HU (Hounsfield units) in 15 patients and lower than 2000 HU in 6. fourteen of 15 patients (93.3%) with concretions having CT densities higher than 2000 HU had a postoperative diagnosis of maxillary sinus aspergillosis. The mean CT density of the sinus concretions in patients with maxillary sinus aspergillosis was 2868 HU (range 1870-3070 HU), and in patients without aspergillosis was 778 HU (range 228-2644 HU). The mean CT density of the dental root-filling material was 2866 HU (range 2156-3070 HU). Paranasal sinus CT with CT densitometry of a sinus concretion has a higher accuracy than standard radiography and clinical findings in the prediction of maxillary sinus aspergillosis (93.3% vs 71.4%). CT densitometry helps to confirm the dental origin of maxillary sinus concretions and to explain a possible dental pathogenesis of maxillary sinus aspergillosis.
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Affiliation(s)
- F X Lenglinger
- Department of Radiology, Allgemeines Krankenhaus Wels der Barmherzigen Schwestern vom Heiligen Kreuz, Austria
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33
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Hussain S, Salahuddin N, Ahmad I, Salahuddin I, Jooma R. Rhinocerebral invasive mycosis: occurrence in immunocompetent individuals. Eur J Radiol 1995; 20:151-5. [PMID: 7588871 DOI: 10.1016/0720-048x(95)00644-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We report the computed tomographic appearance of invasive fungal disease of the paranasal sinuses in 13 patients. Coronal and axial computed tomographic images were obtained in each patient and data were analysed. Eight patients had Aspergillus flavus infection, four had Mucormycosis, and one had mixed Candida and Mucor. Our experience was different from that of other workers in many respects. All of our patients were immunocompetent. On radiological imaging by computed tomography, ethmoid sinuses were involved in 85% of our patients. In previously reported series maxillary sinuses were most frequently affected. Calcification in the inflammatory mass was not encountered in any of our patients, whereas this feature was present in many reported cases. Features in our patients that were similar to other studies were contrast enhancement, extension of the disease into the orbit and cranial cavity and a high mortality. The clinical course and radiological features of invasive mycosis simulate malignancy. Certain features that may help to differentiate invasive fungal infection from malignancy are discussed. We conclude that invasive fungal infection can affect immunocompetent individuals and should be considered in the differential diagnosis in appropriate clinical settings.
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Affiliation(s)
- S Hussain
- Department of Radiology, Aga Khan University Medical Center, Karachi, Pakistan
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34
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Krennmair G, Lenglinger F. Maxillary sinus aspergillosis: diagnosis and differentiation of the pathogenesis based on computed tomography densitometry of sinus concretions. J Oral Maxillofac Surg 1995; 53:657-63; discussion 663-4. [PMID: 7776048 DOI: 10.1016/0278-2391(95)90164-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The efficacy of preoperative computed tomography (CT) densitometry in evaluating the origin of sinus concretions (SC) in sinus aspergillosis (SA) and its value for differentiation between a dental (endodontic) and an aerogenic pathogenesis were examined. PATIENTS AND METHODS Thirty-two patients who demonstrated radiodense maxillary sinus concretions in standard radiography underwent an additional preoperative CT examination of the maxillary sinus and the SC. The density of the SC and the root canal filling materials was assessed. The SC were subdivided into organic (< 1,500 HU) and inorganic (> 1,500 HU) masses; this classification was useful in the differentiation between a dental and an aerogenic pathogenesis of SA. RESULTS SA was diagnosed in 22 patients (68.8%). The SC of SA patients had a density of 2,566.5 +/- 713.6 HU, whereas those of patients without SA had a density of 1,159.9 +/- 1,008.4 HU (P < .01). A correlation between the density of inorganic SC and that of root filling materials was found (r = .78, P < .01). CONCLUSION CT densitometry allows a classification of SC into two subgroups. The correlation between the density of root filling materials and that of radiodense sinus concretions seems to point to a "dental" origin of some concretions in SA. However, "organic" masses found in CT densitomentric examinations represent endogenous fungal products, which indicate an aerogenic pathogenesis of SA. Additional CT examinations of radiodense sinus concretions may thus be of some value for diagnosing SA and differentiating their pathogenesis.
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35
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Oliverio PJ, Benson ML, James Zinreich S. Update On Imaging For Functional Endoscopic Sinus Surgery. Otolaryngol Clin North Am 1995. [DOI: 10.1016/s0030-6665(20)30520-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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36
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Non-invasive aspergillosis of the paranasal sinuses: CT and MRI findings. Eur Radiol 1995. [DOI: 10.1007/bf00957112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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37
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Krennmair G, Lenglinger F, Müller-Schelken H. Computed tomography (CT) in the diagnosis of sinus aspergillosis. J Craniomaxillofac Surg 1994; 22:120-5. [PMID: 8021320 DOI: 10.1016/s1010-5182(05)80022-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
19 patients with radiodense sinus concretions found on standard radiography underwent a preoperative computed tomographic examination of the sinus maxillaris and the sinus concretions. 13 patients (68.4%) with the occurrence of radiodense concretions presented postoperative histologically and microbiologically diagnosed sinus aspergillosis infection. In 13 patients, the sinus concretions had a density higher than 2000 HU (Hounsfield unit) and 6 patients had concretions with a density lower than 2000 HU. 12 (92.3%) of 13 patients with concretions having a density greater than 2000 HU had a postoperatively diagnosed sinus aspergillosis infection. The incidence of diagnosed sinus aspergillosis increased from 68.4% by standard radiography to 92.3% by computed tomographic examination on the supposition that the concretions have a density higher than 2000 HU. The computer tomography (CT)-density of sinus concretions in patients with diagnosed sinus aspergillosis was 2826.7 +/- 362.8 HU. The concretions of patients without sinus aspergillosis had a lower density (788.1 +/- 916.8 HU; p < 0.001). CT-density of root filling material presented nearly the same number in patients with aspergillosis infection (2789.3 +/- 287.5 HU) and in patients without sinus aspergillosis infection (2635.0 +/- 367.8 HU). In patients with diagnosed sinus aspergillosis, a significant correlation between the density of sinus concretions and the density of adjoined dental root filling material was found. Our study demonstrates that an additional preoperative paranasal sinus CT inclusive densitometry of the sinus concretions present is more sensitive than standard radiography for predicting the diagnosis of sinus aspergillosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Krennmair
- Department of Maxillo-Facial Surgery, General Medical Hospital, Wels, Austria
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38
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Saah D, Drakos PE, Elidan J, Braverman I, Or R, Nagler A. Rhinocerebral aspergillosis in patients undergoing bone marrow transplantation. Ann Otol Rhinol Laryngol 1994; 103:306-10. [PMID: 8154773 DOI: 10.1177/000348949410300408] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Rhinocerebral aspergillosis (RA) is becoming increasingly common in patients undergoing bone marrow transplantation (BMT). The disease can involve nearly all major head and neck structures, including the nose, paranasal sinuses, and orbits. Intracranial extension of the infection is of major concern, since this is usually a fatal complication. Our study population comprised 423 consecutive BMT patients at Hadassah University Hospital from January 1986 to August 1992. Eight patients (1.9%) developed RA, 5 of whom had underlying hematologic malignancies, and 3 of whom had severe aplastic anemia. Only 2 of the 8 patients responded completely to therapy, with a follow-up of 15 months. It appears that RA is a fatal complication in immunocompromised patients post-BMT. Early diagnosis followed by extensive surgical debridement of necrotic tissue and systemic, as well as topical, antifungal therapy with amphotericin B or its new formulations and the patient's recovery of bone marrow function may improve the outcome of this life-threatening complication.
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Affiliation(s)
- D Saah
- Department of Otolaryngology-Head and Neck Surgery, Hadassah University Hospital, Jerusalem, Israel
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39
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Nussbaum ES, Hall WA. Rhinocerebral mucormycosis: changing patterns of disease. SURGICAL NEUROLOGY 1994; 41:152-6. [PMID: 8115954 DOI: 10.1016/0090-3019(94)90114-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Eleven cases of rhinocerebral mucormycosis (RM) encountered over a 13-year period were reviewed. Predisposing factors included leukemia (36%), diabetes mellitus (27%), aplastic anemia (9%), myelodysplastic syndrome (9%), and treatment with immunosuppressive medications necessary to maintain solid organ or bone marrow graft viability (64%). Two patients had no predisposing factors. Clinical findings included headache (73%), fever (55%), black nasal eschar (45%), orbitofacial cellulitis (36%), cranial nerve palsy (36%), altered sensorium (36%), and hemiparesis (27%). Seven patients presented with destruction of the paranasal sinuses and local invasion; three with direct extension to the frontal or temporal lobes. Four patients displayed hematogenous dissemination to the cerebrum, brain stem, and cerebellum from a primary pulmonary focus. The seven patients with sinus involvement were treated with aggressive surgical debridement. Two patients with focal intracerebral lesions underwent either open craniotomy or stereotactic biopsy. Amphotericin B was administered intravenously to all patients. Local irrigation via a percutaneous catheter was performed in the seven patients with sinus disease and in one case of intracranial abscess. All seven patients with intracranial infection died, in contrast to four patients that survived with infection localized to the sinuses and orbits. All survivors had been treated with a combination of surgery and amphotericin B therapy. This review demonstrates that RM is increasingly affecting patients with sources of immunosuppression other than diabetes mellitus. Early aggressive therapy to prevent cerebral involvement by this severe infection provides the best chance for a good outcome.
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Affiliation(s)
- E S Nussbaum
- Department of Neurosurgery, University of Minnesota Hospital and Clinic, Minneapolis 55455
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40
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41
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Abstract
Fungal infections including those due to aspergillus are rare in neurosurgical practice despite their possible inclusion in many differential diagnoses. Recently, these diseases have been diagnosed with increasing frequency, principally as opportunistic infections in patients undergoing treatment for diseases resulting in immune compromise. The epidemiology is poorly understood as mycoses are not notifiable diseases. We have recently been involved in the care of seven patients with aspergillosis between 1988 and 1991. Its presentation, with abscess formation, granulomas, the rhinocerebral form, meningitis, hydrocephalus and vascular involvement, is varied. The majority of cases were seen in immunocompromised patients following haematogenous dissemination from a pulmonary or gastro-intestinal focus. Direct spread from sinus infection has also been seen. The prognosis is poor despite modern antifungal treatment, which in part reflects the primary underlying condition.
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Affiliation(s)
- A T Casey
- Department of Neurosurgery, Atkinson Morley's Hospital, London, UK
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42
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43
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Som PM, Curtin HD. CHRONIC INFLAMMATORY SINONASAL DISEASES INCLUDING FUNGAL INFECTIONS. Radiol Clin North Am 1993. [DOI: 10.1016/s0033-8389(22)02192-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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44
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Tyson JC, Gittelman PD, Jacobs JB, Holliday R, Press R. Recurrent mucormycosis of the paranasal sinuses in an immunologically competent host. Otolaryngol Head Neck Surg 1992; 107:115-9. [PMID: 1528591 DOI: 10.1177/019459989210700119] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J C Tyson
- Department of Otolaryngology, New York University School of Medicine, NY 10016
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45
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Marsot-Dupuch K, Cabane J, Raveau V, Aoun N, Tubiana JM. Lethal midline granuloma: impact of imaging studies on the investigation and management of destructive mid facial disease in 13 patients. Neuroradiology 1992; 34:155-61. [PMID: 1603316 DOI: 10.1007/bf00588164] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In 13 patients presenting as lethal midline granuloma (LMG), computed tomography proved essential for determining the extent of the disease, guiding biopsy and planning radiotherapy. Magnetic resonance imaging (MRI) was also helpful for the latter, because it could distinguish fluid retained within the paranasal sinuses from solid masses and tumour from granulation tissue; it was of little value for detecting bone lysis. Eight of the 13 patients proved to have T-cell lymphoma, two had Crohn's disease, in one the lesion was factitious and two had granulomas without diagnostic histological features.
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Affiliation(s)
- K Marsot-Dupuch
- Department of Radiology, Hôpital Saint-Antoine, Paris, France
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46
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Coulthard A, Gholkar A, Sengupta RP. Case report: frontal aspergilloma--a complication of paranasal aspergillosis. Clin Radiol 1991; 44:425-7. [PMID: 1773566 DOI: 10.1016/s0009-9260(05)80666-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aspergillosis is a rare cause of intracranial disease in the non-immunocompromised patient. We report a case of invasive paranasal aspergillosis with extensive frontal lobe involvement, and discuss the role of computed tomography (CT) and magnetic resonance imaging (MRI) in diagnosis.
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Affiliation(s)
- A Coulthard
- Department of Neuroradiology, Newcastle General Hospital, Newcastle upon Tyne
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47
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Estrem SA, Tully R, Davis WE. Rhinocerebral mucormycosis: computed tomographic imaging of cavernous sinus thrombosis. Ann Otol Rhinol Laryngol 1990; 99:160-1. [PMID: 2301872 DOI: 10.1177/000348949009900216] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- S A Estrem
- Division of Otolaryngology-Head and Neck Surgery, University of Missouri-Columbia
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48
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McDevitt GR, Brantley MJ, Cawthon MA. Rhinocerebral mucormycosis: a case report with magnetic resonance imaging findings. Clin Imaging 1989; 13:317-20. [PMID: 2598114 DOI: 10.1016/0899-7071(89)90065-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Mucormycosis is a rare fungal disease most often encountered in patients who are diabetic, immunocompromised, severely burned, or who have a history of intravenous drug abuse. Intracranial presentation includes the isolated cerebral and the more common rhinocerebral forms. The computed tomography picture in mucormycosis is well documented. The magnetic resonance (MR) findings associated with mucormycosis have not been previously described. We report a case of rhinocerebral mucormycosis in a poorly controlled diabetic man where the MR findings of cavernous sinus thrombosis and thrombosis of the cavernous portion of the internal carotid artery demonstrated progression of the patient's disease in spite of his stable clinica course. The results of the MR findings directly altered the patient's therapy, thus leading to a favorable outcome.
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Affiliation(s)
- G R McDevitt
- Brooke Army Medical Center, Department of Radiology, Fort Sam Houston, TX 78234-6200
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49
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50
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Forteza G, Burgeño M, Martorell V, Sierra I. Rhinocerebral mucormycosis. Presentation of two cases and review of the literature. J Craniomaxillofac Surg 1988; 16:80-4. [PMID: 3279068 DOI: 10.1016/s1010-5182(88)80023-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Mucormycosis is a serious infection with a fulminating course caused by opportunistic fungi. The territory most frequently affected is the maxillofacial region. The disease develops in patients with severe metabolic and immunological disorders. We present two cases that illustrate its severity and the need for early diagnosis and aggressive treatment.
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Affiliation(s)
- G Forteza
- Dept. of Maxillofacial Surgery, Hospital La Paz, Madrid, Spain
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