Aspergillosis of the paranasal sinuses--diagnostic significance of the computed tomography

Incidental Findings of Asymptomatic Fungal Infection

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.

Current diagnosis and treatment of rhinosinusal aspergilloma (Review)

There are numerous types of sinusitis caused by fungal strains, some of which already colonize the nasal cavity. Mild forms present fungus balls growing inside a preexisting sinus cavity. The invasive type ranges from chronic manifestations to acute aggravated episodes. The latter scenario is encountered in cases with reduced immune responses, such as patients with diabetes, individuals receiving any form of transplant, AIDS cases and chemotherapy patients. Without the control of immunosuppression, the infection is aggravated and extends to the orbit and inside the skull base, regardless of the prompt surgical and medical treatment. This is the most common pathogenic fungus on the nasal sinuses level. It can occasionally enter the sinus cavity during dental procedures. The pathogenesis is enhanced by anaerobic conditions in poorly ventilated sinus cavities. Rhinosinusal aspergilloma has a slow, insidious evolution over months and even years. Our experience revealed the presence of both a dental problem and previous self-administered antibiotic regimens in almost every case. The initial symptoms are common with sinusitis of dental origin, but aspergilloma should be considered when a patient with a competent immune system does not respond to standard antibiotic treatment. The final diagnosis of rhinosinusal aspergilloma is conducted on a pathology sample with silver staining. The bacteriology exam of the sinus secretion rarely reveals a fungus infection; however, as revealed in our clinical experience, there may be coinfection with other multidrug-resistant bacteria. Surgical treatment must establish a wide exposure of the sinus cavity and correct drainage regardless of the external, combined or endoscopic approach. Early diagnosis and emergency surgical debridement along with administering systemic antifungal compounds in some cases represent the key to the successful treatment of invasive aspergilloma.

Primary Aspergillosis of the Sphenoid Sinus Observed on Bone SPECT/CT

The bone SPECT/CT allows for precise anatomic delineation of bone activity, which can be valuable for diagnosis of nonmalignant bone diseases. We report an extremely rare case of sphenoid sinus aspergillosis, observed on bone SPECT/CT imaging, as an isolated disease in an immunocompetent individual. A 58-year-old woman with a history of plantar fasciitis was assessed for infection in the tarsal bones. Planar bone scan image revealed incidental focal lesion in skull base, which was considered to be the left sphenoid sinusitis by the bone SPECT/CT scan.

Chronic invasive aspergillosis of paranasal sinuses: A case report with review of literature

Aspergillosis of the nasal and paranasal sinuses is recognized as being second to candidiasis, among opportunistic fungal infections in immunocompromised patients. However, invasive variant in normal and mildly immunocompromised hosts is a very rare occurrence. We report one such case of aspergillosis involving paranasal sinuses in mildly immunocompromised patient.

Fine-needle aspiration biopsy as an initial diagnostic modality in a clinically unsuspected case of invasive maxillary fungal sinusitis: A case report

Cases of invasive fungal lesions involving the paranasal sinuses are generally diagnosed either on histologic examination or on fungal culture. Here, we report a case of invasive fungal sinusitis diagnosed primarily by a fine-needle aspiration biopsy (FNAB).Our patient was a 36-year-old male who presented with a history of slowly progressive, painless swelling over the left cheek. The only positive clinical finding was a bony hard swelling in the left maxillary region, which was clinically interpreted as "fibrous dysplasia." A computed tomographic (CT) examination of the paranasal sinuses showed a soft tissue attenuation lesion involving the bilateral maxillae, with the destruction of multiple bones and involvement of multiple sinuses and the bilateral orbits. FNAB of the maxillary swelling showed several giant cells, many of them exhibiting ingested organisms with a morphologic resemblance to the Aspergillus species of fungi. Strikingly, no significant inflammatory cells were seen on cytologic smears. Unfortunately, owing to a lack of initial clinical suspicion, as well as the patient's loss to further follow-up, a culture/histopathologic examination could not be carried out.This case is presented chiefly to highlight the clinical utility of a simple FNAB procedure, as an initial diagnostic modality in cases of fungal sinusitis, which can masquerade clinically as a neoplastic lesion. In addition, if radiologic findings are also available at the time of cytologic examination, a pretherapeutic comment on the invasive nature of the lesion can also be made.

Parasellar Aspergillus granuloma extending from the sphenoid sinus: report of two cases

BACKGROUND

Sphenoid sinus aspergillosis is a rare disease known to show an aggressive course with high mortality. Early diagnosis, though difficult, is required to prevent lethal fungal meningoencephalitis.

CASE REPORT

We describe two cases of parasellar Aspergillus granuloma extending from the sphenoid sinus clinically indistinguishable from intracranial neoplasms. In the first patient, the fungus colony was visualized by computed tomography (CT) and magnetic resonance imaging (MRI) as a calcified concretion and total removal was curative. In the second patient, partial removal and subsequent antifungal therapy had minimal effect.

CONCLUSIONS

The prognosis of the patients with this disease depends on prompt surgical treatment before intradural invasion occurs, and CT and MRI are useful diagnostic maneuvers for detecting calcified Aspergillus colonies.