1
|
Sepúlveda A I, Rivas-Rodriguez F, Capizzano AA. Imaging of the Sinonasal Cavities. Dent Clin North Am 2024; 68:337-355. [PMID: 38417994 DOI: 10.1016/j.cden.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
This article describes the various abnormalities that affect the sinonasal cavities and discusses inflammations, tumors, and tumor-like conditions. Specific imaging evaluations that focus on the sinonasal cavities are described in more detail.
Collapse
Affiliation(s)
- Ilson Sepúlveda A
- Finis Terrae University School of Dentistry, Santiago, Chile; Radiology Department, ENT-Head&Neck Surgery and Maxillofacial Services, General Hospital of Concepción, San Martín Av. N° 1436, Concepción, Chile.
| | - Francisco Rivas-Rodriguez
- Division of Neuroradiology, University of Michigan, 1500 East Medical Center Dr, B2A205, Ann Arbor, MI 48109-5302, USA
| | - Aristides A Capizzano
- Division of Neuroradiology, University of Michigan, 1500 East Medical Center Dr, B2A205, Ann Arbor, MI 48109-5302, USA
| |
Collapse
|
2
|
Tine A, Maldonado SM, Cloran FJ. The vanishing nasal septum sign: a case of severe fungal sinusitis. Emerg Radiol 2023; 30:807-810. [PMID: 37845401 DOI: 10.1007/s10140-023-02176-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 10/18/2023]
Abstract
Acute invasive fungal sinusitis (AIFS) is a fungal infection of the nasal cavity and paranasal sinuses with associated invasion of adjacent vessels and soft/hard tissues. It usually occurs in immunocompromised patients and may follow a rapid course of less than four weeks with high mortality rate. We report a 39-year-old male with relapse of acute myelogenous leukemia (AML) who was under evaluation for neutropenic fever. On his sinus CT, there was loss of calcification of his nasal septum when compared to a prior head CT, a sign indicative of an aggressive infectious process. He was diagnosed with AIFS and underwent emergent surgical debridement and systemic antifungal therapy, leading to a positive outcome. The sign described on CT ("Vanishing Nasal Septum" sign) may provide an additional, reliable tool to prospectively identify locally aggressive cases of invasive fungal infections of the nasal cavity at an earlier stage and improve patient outcomes.
Collapse
Affiliation(s)
- Albert Tine
- Alabama College of Osteopathic Medicine, 445 Health Sciences Blvd, Dothan, AL, 36603, USA.
| | - Sarina Masso Maldonado
- Department of Radiology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA
| | - Francis J Cloran
- Department of Radiology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA
| |
Collapse
|
3
|
Senapathy G, Putta T, Sistla SK. Magnetic resonance imaging in COVID-19-associated acute invasive fungal rhinosinusitis - Diagnosis and beyond. J Clin Imaging Sci 2023; 13:23. [PMID: 37680251 PMCID: PMC10481822 DOI: 10.25259/jcis_46_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/21/2023] [Indexed: 09/09/2023] Open
Abstract
Objectives The aim of the study was to evaluate the magnetic resonance imaging (MRI) features of acute invasive fungal rhinosinusitis (AIFRS) at presentation and on follow-up imaging when patients receive treatment with systemic antifungal therapy and surgical debridement. Material and Methods This is a retrospective analysis of imaging data from a cohort of patients diagnosed with AIFRS during the second wave of COVID-19 in single tertiary referral hospital in South India between March 2021 and May 2021 (n = 68). Final diagnosis was made using a composite reference standard which included a combination of MRI findings, clinical presentation, nasal endoscopy and intraoperative findings, and laboratory proof of invasive fungal infection. Analysis included 62 patients with "Definite AIFRS" findings on MRI and another six patients with "Possible AIFRS" findings on MRI and laboratory proof of invasive fungal infection. Follow-up imaging was available in 41 patients. Results The most frequent MRI finding was T2 hypointensity in the sinonasal mucosa (94%) followed by mucosal necrosis/loss of contrast-enhancement (92.6%). Extrasinosal inflammation with or without necrosis in the pre-antral fat, retroantral fat, pterygopalatine fossa, and masticator space was seen in 91.1% of the cases. Extrasinosal spread was identified on MRI even when the computed tomography (CT) showed intact bone with normal extrasinosal density. Orbital involvement (72%) was in the form of contiguous spread from either the ethmoid or maxillary sinuses; the most frequent presentation being orbital cellulitis and necrosis, with some cases showing extension to the orbital apex (41%) and inflammation of the optic nerve (32%). A total of 22 patients showed involvement of the cavernous sinuses out of which 10 had sinus thrombosis and five patients had cavernous internal carotid artery involvement. Intracranial extension was seen both in the form of contiguous spread to the pachymeninges over the frontal and temporal lobes (25%) and intra-axial involvement in the form of cerebritis, abscesses, and infarcts (8.8%). Areas of blooming on SWI were noted within the areas of cerebritis and infarcts. Perineural spread of inflammation was seen along the mandibular nerves across foramen ovale in five patients and from the cisternal segment of trigeminal nerve to the root exit zone in pons in three patients. During follow-up, patients with disease progression showed involvement of the bones of skull base, osteomyelitis of the palate, alveolar process of maxilla, and zygoma. Persistent hyperenhancement in the post-operative bed after surgical debridement and resection was noted even in patients with stable disease. Conclusion Contrast-enhanced MRI must be performed in all patients with suspected AIFRS as non-contrast MRI fails to demonstrate tissue necrosis and CT fails to demonstrate extrasinosal disease across intact bony walls. Orbital apex, pterygopalatine fossa, and the cavernous sinuses form important pathways for disease spread to the skull base and intracranial compartment. While cerebritis, intracranial abscesses, and infarcts can be seen early in the disease due to the angioinvasive nature, perineural spread and skull base infiltration are seen 3-4 weeks after disease onset. Exaggerated soft-tissue enhancement in the post-operative bed after debridement can be a normal finding and must not be interpreted as disease progression.
Collapse
Affiliation(s)
- Gayatri Senapathy
- Department of Radiology, Asian Institute of Gastroenterology Hospitals, Hyderabad, Telangana, India
| | - Tharani Putta
- Department of Radiology, Asian Institute of Gastroenterology Hospitals, Hyderabad, Telangana, India
| | - Srinivas Kishore Sistla
- Department of ENT, Asian Institute of Gastroenterology Hospitals, Hyderabad, Telangana, India
| |
Collapse
|
4
|
Benites G, Urbančič J, Bardales C, Vozel D. Sinonasal Orbital Apex Syndrome, Horner Syndrome and Pterygopalatine Fossa Infection: A Case Report and Mini-Review. Life (Basel) 2023; 13:1658. [PMID: 37629515 PMCID: PMC10455385 DOI: 10.3390/life13081658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
This paper presents a literature review and a case of an 83-year-old otherwise healthy female patient with a history of recent syncope, a sudden-onset right-sided temporal headache, diplopia, and vision loss. An exam revealed right-sided upper eyelid ptosis, myosis, vision loss, ophthalmoplegia, and a positive relative afferent pupillary defect on the right eye. CT showed sphenoid sinus opacification, eroded lateral sinus wall, Vidian canal, disease extension to the posterior ethmoid air cells, orbital apex, medial orbital wall, and pterygopalatine fossa. An orbital apex syndrome (Jacod's syndrome), Horner syndrome, and pterygopalatine fossa infection were diagnosed due to the acute invasive fungal sinusitis developed from a sphenoid sinus fungal ball. The patient was treated with antimicrobial therapy and transnasal endoscopic surgery twice to decompress the orbital apex, drain the abscess and obtain specimens for analysis. The right-sided ptosis, visual loss, ophthalmoplegia, and headache resolved entirely. No immune or comorbid diseases were identified, microbiological and histopathological analyses were negative, and MRI could not be performed on the presented patient. For that reason, the diagnostic procedure was non-standard. Nevertheless, the treatment outcome of this vision and life-threatening disease was satisfactory. Treating the fungal ball in an older or immunocompromised patient is essential to prevent invasive fungal rhinosinusitis and fatal complications.
Collapse
Affiliation(s)
- Gregorio Benites
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Trujillo, Roma Avenue 338, Trujillo 13001, Peru (C.B.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia;
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Jure Urbančič
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia;
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Carolina Bardales
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Trujillo, Roma Avenue 338, Trujillo 13001, Peru (C.B.)
- Departamento de Cirugía, Especialidad de Otorrinolaringología, Hospital Belen de Trujillo, Bolivar Street 350, Trujillo 13001, Peru
| | - Domen Vozel
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia;
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| |
Collapse
|
5
|
Baba A, Kurokawa R, Kurokawa M, Reifeiss S, Policeni BA, Ota Y, Srinivasan A. Advanced imaging of head and neck infections. J Neuroimaging 2023. [PMID: 36922159 DOI: 10.1111/jon.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023] Open
Abstract
When head and neck infection is suspected, appropriate imaging contributes to treatment decisions and prognosis. While contrast-enhanced CT is the standard imaging modality for evaluating head and neck infections, MRI can better characterize the skull base, intracranial involvement, and osteomyelitis, implying that these are complementary techniques for a comprehensive assessment. Both CT and MRI are useful in the evaluation of abscesses and thrombophlebitis, while MRI is especially useful in the evaluation of intracranial inflammatory spread/abscess formation, differentiation of abscess from other conditions, evaluation of the presence and activity of inflammation and osteomyelitis, evaluation of mastoid extension in middle ear cholesteatoma, and evaluation of facial neuritis and labyrinthitis. Apparent diffusion coefficient derived from diffusion-weighted imaging is useful for differential diagnosis and treatment response of head and neck infections in various anatomical sites. Dynamic contrast-enhanced MRI perfusion may be useful in assessing the activity of skull base osteomyelitis. MR bone imaging may be of additional value in evaluating bony structures of the skull base and jaw. Dual-energy CT is helpful in reducing metal artifacts, evaluating deep neck abscess, and detecting salivary stones. Subtraction CT techniques are used to detect progressive bone-destructive changes and to reduce dental amalgam artifacts. This article provides a region-based approach to the imaging evaluation of head and neck infections, using both conventional and advanced imaging techniques.
Collapse
Affiliation(s)
- Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott Reifeiss
- Department of Radiology, Roy Caver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Bruno A Policeni
- Department of Radiology, Roy Caver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
6
|
Li CX, Gong ZC, Pataer P, Shao B, Fang C. A retrospective analysis for the management of oromaxillofacial invasive mucormycosis and systematic literature review. BMC Oral Health 2023; 23:115. [PMID: 36810012 PMCID: PMC9942087 DOI: 10.1186/s12903-023-02823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
PURPOSE Mucormycosis is a type of fatal infectious disease, rarely involved in the oromaxillofacial region. This study aimed to describe a series of 7 cases with oromaxillofacial mucormycosis and to discuss the epidemiology, clinical features, and treatment algorithm thereof. METHODOLOGY Seven patients in the author's affiliation have been treated. They were assessed and presented as per their diagnostic criteria, surgical approach, and mortality rates. Reported cases of mucormycosis originally happened in craniomaxillofacial region were synthesized through a systematic review so as to better discuss its pathogenesis, epidemiology, and management. RESULTS Six patients had a primary metabolic disorder, and one immunocompromised patient had a history of aplastic anemia. The criteria for a positive diagnosis of invasive mucormycosis were based on clinical presentation of signs and symptoms, and a biopsy for microbiological culture and histopathologic analysis. Each patient used antifungal drugs and five of them also underwent surgical resection at the same time. Four patients died due to the unregulated spread of mucormycosis, and one patient died owing to her main disease. CONCLUSIONS Although uncommon in clinical practice setting, mucormycosis should be of great concern in oral and maxillofacial surgery, due to the life-threatening possibility of this disease. The knowledge of early diagnosis and prompt treatment is of utmost importance for saving lives.
Collapse
Affiliation(s)
- Chen-xi Li
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China ,grid.33199.310000 0004 0368 7223Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, 430022 People’s Republic of China
| | - Zhong-cheng Gong
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
| | - Parekejiang Pataer
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
| | - Bo Shao
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
| | - Chang Fang
- grid.412631.3Department of Oral and Maxillofacial Oncology and Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology, Xinjiang Medical University, Stomatological Research Institute of Xinjiang Uygur Autonomous Region, No.137 Liyushan South Road, Ürümqi, 830054 People’s Republic of China
| |
Collapse
|
7
|
Talati VM, Brown HJ, Kim YJ, Allen-Proctor MK, Gattuso P, Mahdavinia M, Papagiannopoulos P, Batra P, Tajudeen BA. Histopathologic Features of Chronic Rhinosinusitis in Diabetic Patients. Otolaryngol Head Neck Surg 2023. [PMID: 36939423 DOI: 10.1002/ohn.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To explore how diabetes mellitus impacts chronic rhinosinusitis clinically and on structured histopathology to provide insights on new potential chronic rhinosinusitis endotypes. STUDY DESIGN Retrospective cohort study. SETTING Tertiary academic center. METHODS A retrospective study of chronic rhinosinusitis patients who underwent functional endoscopic sinus surgery from 2015 to 2020 was performed. Structured 13-variable histopathology reports were generated from intraoperative sinonasal specimens. These variables were compared against demographic factors, comorbidities, culture data, and preoperative Lund-Mackay and SNOT-22 scores using logistic regression. RESULTS There were 411 patients, including 52 diabetics. Diabetes was associated with higher mean body mass index (34.9 vs 29.2; p < .001), age (57.8 vs 48.0; p < .001), and Gram-negative (40.2% vs 22.7%; p < .030) and coagulase-negative Staphylococcus (49.0% vs 28.5%; p = .008) culture rates. Black (23.1% vs 18.7%) and Hispanic (23.1% vs 8.6%) races were more common with diabetes (p = .026). Gender, smoking, polyp status, and Lund-Mackay and SNOT-22 scores did not differ between groups. Diabetics had more fungal elements (13.5% vs 3.3%, p = .018); no other histopathological differences were seen. When controlling for demographic variables and comorbidities, diabetes independently predicted the presence of fungal elements (HR 4.38, p = .018). CONCLUSION Diabetic chronic rhinosinusitis patients demonstrated increased fungal elements on structured histopathology. Other histopathological features were unaffected by diabetes. These findings may have important implications on the medical and surgical management of diabetic chronic rhinosinusitis patients in which early fungal disease assessment is paramount.
Collapse
Affiliation(s)
- Vidit M Talati
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hannah J Brown
- Department of Otolaryngology-Head and Neck Surgery, Kansas University Medical Center, Kansas City, Kansas, USA
| | - Young-Jae Kim
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Mahboobeh Mahdavinia
- Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, USA.,Section of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Pete Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Rush Sinus, Allergy, and Asthma Center, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
8
|
Hagiwara M, Policeni B, Juliano AF, Agarwal M, Burns J, Dubey P, Friedman ER, Gule-Monroe MK, Jain V, Lam K, Patino M, Rath TJ, Shian B, Subramaniam RM, Taheri MR, Zander D, Corey AS. ACR Appropriateness Criteria® Sinonasal Disease: 2021 Update. J Am Coll Radiol 2022; 19:S175-S193. [PMID: 35550800 DOI: 10.1016/j.jacr.2022.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 11/26/2022]
Abstract
This article presents guidelines for initial imaging utilization in patients presenting with sinonasal disease, including acute rhinosinusitis without and with suspected orbital and intracranial complications, chronic rhinosinusitis, suspected invasive fungal sinusitis, suspected sinonasal mass, and suspected cerebrospinal fluid leak. CT and MRI are the primary imaging modalities used to evaluate patients with sinonasal disease. Given its detailed depiction of bony anatomy, CT can accurately demonstrate the presence of sinonasal disease, bony erosions, and anatomic variants, and is essential for surgical planning. Given its superior soft tissue contrast, MRI can accurately identify clinically suspected intracranial and intraorbital complications, delineate soft tissue extension of tumor and distinguish mass from obstructed secretions.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | - Mari Hagiwara
- Neuroradiology Fellowship Program Director, New York University Langone Health, New York, New York.
| | - Bruno Policeni
- Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy F Juliano
- Panel Vice-Chair and Director of Research and Academic Affairs, Mass Eye and Ear, Harvard Medical School, Boston, Massachusetts; ACR Chair NI-RADS Committee
| | - Mohit Agarwal
- Fellowship Program Director, Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Judah Burns
- Residency Program Director, Diagnostic Radiology, Montefiore Medical Center, Bronx, New York
| | - Prachi Dubey
- Houston Methodist Hospital, Houston, Texas; Alternate Councilor, Texas Radiological Society; and Member, ACR Neuroradiology Commission
| | | | - Maria K Gule-Monroe
- Medical Director of Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vikas Jain
- Assistant Program Director of Radiology Residency Program, MetroHealth Medical Center, Cleveland, Ohio
| | - Kent Lam
- Eastern Virginia Medical School, Norfolk, Virginia; Rhinology and Paranasal Sinus Committee Member, American Academy of Otolaryngology - Head and Neck Surgery; Consultant to the Board, American Rhinologic Society
| | - Maria Patino
- University of Texas Health Science Center, Houston, Texas
| | - Tanya J Rath
- Division Chair of Neuroradiology, Education Director of Neuroradiology, Mayo Clinic Arizona, Phoenix, Arizona; President of the Eastern Neuroradiological Society
| | - Brian Shian
- Primary Care Physician, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Rathan M Subramaniam
- University of Otago, Dunedin, Otepoti, New Zealand; Co-Chair, ACR Committee on Practice Parameters and Technical Standards - Nuclear Medicine and Molecular Imaging
| | - M Reza Taheri
- Director of Neuroradiology, George Washington University Hospital, Washington, District of Columbia
| | - David Zander
- Chief of Head and Neck Radiology, University of Colorado Denver, Denver, Colorado
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
| |
Collapse
|
9
|
Ho NH, Hung LT, Kuan EC, Ho CY, Hsu CC, Lan MY. Combining sinus plain film and sinus ultrasound as a screening tool for maxillary fungal sinusitis. J Chin Med Assoc 2022; 85:375-380. [PMID: 34812769 DOI: 10.1097/jcma.0000000000000669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Early identification of fungal sinusitis remains a challenge. Previously, we observed a high false negative rate of using A-mode ultrasound to diagnose maxillary fungal sinusitis. This study aims to assess the accuracy of the diagnosis of fungal maxillary sinusitis using sinus plain film and ultrasound. METHODS The screening criteria is defined as the combination of a positive sinus plain film and a false negative sinus ultrasound. We retrospectively reviewed preoperative imaging of patients with fungal sinusitis and unilateral bacterial sinusitis of the maxillary sinus undergoing functional endoscopic sinus surgery from May 2013 to December 2019 in our hospital and evaluated the diagnostic performance of this screening method. RESULTS Forty-eight patients were included. Twenty-two and 26 patients were diagnosed with fungal sinusitis and bacterial sinusitis, respectively. Sixteen patients (72.7%) with fungal sinusitis presented with a false negative sinus ultrasound and met our screening criteria for fungal sinusitis. The screening criteria reached significance in the receiver operating characteristic curve analysis (p < 0.001). The area under the curve was 0.829. The sensitivity, specificity, and accuracy are 72.7%, 93.2%, and 88.4%, respectively. CONCLUSION A high false negative rate of sinus ultrasound in patients with fungal sinusitis was found. A positive sinus plain film combined with a false negative sinus ultrasound can potentially become an easy and cost-effective screening tool for diagnosing fungal maxillary sinusitis before consideration of computed tomography scanning.
Collapse
Affiliation(s)
- Nien-Hsuan Ho
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC
| | - Li-Ting Hung
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Edward C Kuan
- Department of Otolaryngology, University of California, Irvine, Orange, CA, USA
| | - Ching-Yin Ho
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Otolaryngology, Cheng Hsin Hospital, Taipei, Taiwan, ROC
| | - Cheng-Chieh Hsu
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Ying Lan
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| |
Collapse
|
10
|
Khullar T, Kumar J, Sindhu D, Garg A, Meher R. CT imaging features in acute invasive fungal rhinosinusitis- recalling the oblivion in the COVID era. Curr Probl Diagn Radiol 2022; 51:798-805. [PMID: 35249797 PMCID: PMC8820107 DOI: 10.1067/j.cpradiol.2022.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/21/2022] [Accepted: 02/01/2022] [Indexed: 12/21/2022]
Abstract
Objective Methods Results Conclusion
Collapse
Affiliation(s)
- Tamanna Khullar
- Department of Radio-diagnosis, Maulana Azad Medical College, New Delhi, India
| | - Jyoti Kumar
- Department of Radio-diagnosis, Maulana Azad Medical College, New Delhi, India.
| | - Deeksha Sindhu
- Department of Radio-diagnosis, Maulana Azad Medical College, New Delhi, India
| | - Anju Garg
- Department of Radio-diagnosis, Maulana Azad Medical College, New Delhi, India
| | - Ravi Meher
- Department of Otorhinolaryngology (ENT), Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
11
|
Luizeti BO, Lima LARD, Spies JW, Sella GCP. Rare Presentations of Frontal Sinus Fungus Ball: A Systematic Review. Int Arch Otorhinolaryngol 2022; 26:e738-e743. [DOI: 10.1055/s-0041-1740598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction The sinus fungus ball is an agglomeration of debris and hyphae, mainly caused by Aspergillus fumigatus, within the paranasal sinus, commonly affecting a single sinus, and it only rarely affects the frontal sinus.
Objective To identify the state of the art of fungus ball in paranasal sinuses, especially related to the epidemiology of the disease in the frontal sinus. Additionally, this article reports a rare case of fungus ball in the frontal sinus in an adult male, and discusses the variables of this condition related to the patient.
Data Synthesis All of the 8 cases of fungus ball in the frontal sinus reported in this study affected male patients: 40% had unilateral disease, and 60%, bilateral disease, contrary to the incidence data of fungus ball in the other paranasal sinuses, which reports unilateral prevalence. However, in the present study, this index changes, with 50% of unilateral and 50% of bilateral incidence regarding frontal sinus involvement. The average age of the patients was 65.36 years (range: 60-74 years). The etiologic agent was Aspergillus spp., and the endonasal endoscopic therapeutic approach corresponded to 80% of cases, while frontal osteoplasty accounted for 20% of cases, reaffirming the prevalence data from other studies.
Conclusion Despite being a low-incidence entity, frontal sinus fungus ball should be considered in patients with pain in the frontal region refractory to the usual clinical treatments.
Collapse
Affiliation(s)
| | - Lesley Ane Roks de Lima
- Department of Medicine, Faculdade de Medicina, Universidade Cesumar, Maringá, Paraná, Brazil
| | - Jonas Willian Spies
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Faculdade de Medicina de Ribeirão Preto, Universidade de of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, São Paulo, Brazil
| | - Guilherme Constante Preis Sella
- Department of Medicine, Faculdade de Medicina, Universidade Cesumar, Maringá, Paraná, Brazil
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Faculdade de Medicina de Ribeirão Preto, Universidade de of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, São Paulo, Brazil
- Academia Brasileira de Cirurgia Plástica da Face (ABCPF), São Paulo, São Paulo, Brazil
| |
Collapse
|
12
|
Sweed AH, Mobashir M, Elnashar I, Anany A, Elmaghawry ME, Ibrahim EM, Eesa M. MRI as a road-map for surgical intervention of acute invasive fungal sinusitis in Covid-19 era. Clin Otolaryngol 2021; 47:388-392. [PMID: 34954903 DOI: 10.1111/coa.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/23/2021] [Accepted: 12/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Acute invasive fungal sinusitis AIFS has high mortality rate, and its incidence has increased without explanation in Covid-19 era. Proper diagnosis and effective surgical debridement have a crucial role in decreasing this high mortality rate. MRI could detect early ischemic changes with localization of extrasinus devitalized fungal inflamed tissue to guide surgical intervention. STUDY DESIGN Prospective study SETTING: ORL-HNS department -Zagazig University. METHODS T1 with gadolinium and T2 fat suppression sequences were investigated and correlated with surgical findings in cases recently recovered from Covid-19 "seroconversion". Loss of contrast enhancement LOCE/black sign in T1+G was hypothesized to reflect necrotic areas while hyperintense signal/white sign in T2 fat suppression was hypothesized to correlate with severely inflamed devitalized tissue in periantral region These radiological findings were correlated with intraoperative findings to identify positive predictive finding. RESULTS 40 patients were included in this study, of which 38 had LOCE/ black sign in T1+G 95%. True ischemic turbinate was detected only in 35 cases (positive predictable value PPV= 92.1%). Hyperintense signal/ white sign in T2 fat suppression was detected in orbit, pterygopalatine-infratemporal fossa, sphenoid process, zygoma, external skin, and these findings were correlated with intraoperative findings (PPV ranging from 72.7% to 100%). CONCLUSION MRI has a crucial role in localization of devitalized tissue, and subsequently guides surgical intervention.
Collapse
Affiliation(s)
- Ahmed Hassan Sweed
- Lecturer of Otorhinolaryngology, Zagazig University, faculty of medicine, Egypt
| | - Mohamed Mobashir
- Professor of Otorhinolaryngology, Zagazig University, faculty of medicine, Egypt
| | - Ismail Elnashar
- Professor of Otorhinolaryngology, Zagazig University, faculty of medicine, Egypt
| | - Ahmed Anany
- Professor of Otorhinolaryngology, Zagazig University, faculty of medicine, Egypt
| | | | - Enas Moustafa Ibrahim
- Assistant lecture of diagnostic radiology, Zagazig University, faculty of medicine, Egypt
| | - Mohamed Eesa
- Lecturer of Otorhinolaryngology, Zagazig University, faculty of medicine, Egypt
| |
Collapse
|
13
|
Acute and chronic invasive fungal sinusitis and imaging features: A review. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.1024568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
14
|
RADIOLOGICAL EVALUATION OF ALLERGIC FUNGAL SINUSITIS: NOVEL FINDINGS. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.1020505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
15
|
Saad RH, Mobarak FA. The diversity and outcome of post-covid mucormycosis: A case report. Int J Surg Case Rep 2021; 88:106522. [PMID: 34692373 PMCID: PMC8522488 DOI: 10.1016/j.ijscr.2021.106522] [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: 09/04/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction and importance The impact of Covid-19 pandemic on the incidence and pattern of Mucormycosis (the black fungus), has increased sharply and is featured as an epidemic within a pandemic. The majority of cases were detected at late stages, which decreases the chances of survival. Case presentation The authors present a case of an immunocompetent male patient diagnosed with left orbital apex syndrome post covid-19 infection, which necessitated orbital exenteration. He was later hospitalized in a quarantine facility and an area of skin breakdown on his left cheek was noted and surgical debridement performed. Later, He presented to our institution with left hemifacial skin loss, exposing the underlying diseased bone. A multidisciplinary team examined the patient clinically and radiographically, reaching a primitive diagnosis of secondary cutaneous Mucormycosis due to rhino-orbital Mucormycosis, with no cavernous sinus thrombosis nor cranial extension. Radical surgical and medical treatments were given and he had an uneventful recovery. Unfortunately, he died 5 days after the reconstructive surgery with Anterolateral Thigh (ALT) flap. Clinical discussion The dual effect of both covid-19 and its' associated Mucormycosis, predispose patients to increased risk of pressure injuries including Medical device related pressure injuries. Survivors of Mucormycosis are high-risk patients, and planning their reconstruction by free flaps is challenging. However, delayed reconstruction is recommended. Conclusion Early diagnosis and management of covid-19 associated Mucormycosis should be prioritized. Moreover, surgical debridement of necrotic tissues should not be delayed due to an unavailable or negative histopathology. Medical device related pressure injuries (MDRPIs) is an iatrogenic injury, and its prevention and management should be prioritized. Mucormycosis should be investigated in COVID-19 infected and recovered patients. Cutaneous Mucormycosis is common among the immunocompetent patients, and knowledge of its types and subtypes is essential. The authors highlight the value of clinical and radiographic investigation in aiding early diagnosis of Mucormycosis. Surgical debridement of necrotic tissues is a life-saving measure, and should not be delayed due to an unavailable or negative histopathology.
Collapse
Affiliation(s)
- Reem Hassan Saad
- Department of Cranio-Maxillofacial Surgery, Nasser Institute for Research and Treatment, Cairo, Egypt.
| | - Fahmy A Mobarak
- Head of Department of Cranio-Maxillofacial Surgery, Nasser Institute for Research and Treatment, Cairo, Egypt
| |
Collapse
|
16
|
Imaging findings using a combined MRI/CT protocol to identify the "entire iceberg" in post-COVID-19 mucormycosis presenting clinically as only "the tip". Clin Radiol 2021; 76:784.e27-784.e33. [PMID: 34353524 DOI: 10.1016/j.crad.2021.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/09/2021] [Indexed: 01/08/2023]
Abstract
AIM To analyse combined computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of invasive rhino-orbital mucormycosis (IROM) in post-COVID-19 infection patients for accurate diagnosis and delineation of the extent of involvement. MATERIALS AND METHODS A retrospective analysis was undertaken of 50 patients who developed IROM post-COVID-19 infection who underwent combined CT/MRI evaluation. RESULTS The age range of the 50 affected patients was 23-73 years. Out of these, 41 were diabetic. CT/MRI showed predominant involvement of the maxillary (n=26) and ethmoid (n=19) sinuses. Extension of disease to the orbit (n=35), cavernous sinus (n=18), hard palate (n=15), skull base (n=8), and intracranial involvement (n=3) was seen. Perineural spread of the disease was analysed along all divisions of the trigeminal nerve and its branches. MRI showed T2-hypointense soft-tissue thickening with heterogeneous contrast enhancement with corresponding hyperdensities on CT diagnosing the presence of fungal elements. CONCLUSION Clinicians should be aware of the possibility of IROM post-COVID-19 infection. Conjunctive use of CT, which depicts bone destruction and other reactive bony changes along with MRI, which reveals characteristic findings of soft-tissue thickening of the involved sinuses with extension of disease to the orbits, cavernous sinus, dura, hard palate, skull base, and intracranial structures. Accurate diagnosis and early recognition of the disease and its extension with appropriate use of these techniques helps to initiate appropriate and timely treatment, which is vital to prevent a fatal outcome.
Collapse
|
17
|
Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the "black fungus". Clin Radiol 2021; 76:812-819. [PMID: 34364672 PMCID: PMC8316064 DOI: 10.1016/j.crad.2021.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/20/2021] [Indexed: 12/26/2022]
Abstract
A subset of diabetic COVID-19 patients treated with steroids, oxygen, and/or prolonged intensive care admission develop rhino-orbito-cerebral mucormycosis. Radiologists must have a high index of suspicion for early diagnosis, which prompts immediate institution of antifungal therapy that limits morbidity and mortality. Assessment of disease extent by imaging is crucial for planning surgical debridement. Complete debridement of necrotic tissue improves survival. Imaging features reflect the angioinvasive behaviour of fungal hyphae from the Mucoraceae family, which cause necrotising vasculitis and thrombosis resulting in extensive tissue infarction. Contrast-enhanced magnetic resonance imaging (MRI) is the imaging technique of choice. The classic “black turbinate” on contrast-enhanced imaging represents localised invasive fungal rhinosinusitis (IFRS). A striking radiological feature of disseminated craniofacial disease is non-enhancing devitalised and necrotic soft tissue at the orbits and central skull base. Sinonasal and extrasinonasal non-enhancing lesions in IFRS are secondary to coagulative necrosis induced by fungal elements. Multicompartmental and extrasinonasal tissue infarction is possible without overt bone involvement and caused by the propensity of fungal elements to disseminate from the nasal cavity via perineural and perivascular routes. Fungal vasculitis can result in internal carotid artery occlusion and cerebral infarction. Remnant non-enhancing lesions after surgical debridement portend a poor prognosis. Assessment for the non-enhancing MRI lesion is crucial, as it is a sole independent prognostic factor for IFRS-specific mortality. In this review, we describe common and uncommon imaging presentations of biopsy-proven rhino-orbito-cerebral mucormycosis in a cohort of nearly 40 COVID-19 patients.
Collapse
|
18
|
Phenotypes of Chronic Rhinosinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:1505-1511. [PMID: 32389275 DOI: 10.1016/j.jaip.2019.12.021] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 12/20/2022]
Abstract
Chronic rhinosinusitis (CRS) is a complex heterogeneous disease with different phenotypes and endotypes. Recent advances in our understanding of the pathogenetic mechanisms of CRS endotypes have led to the introduction of effective biologic agents for CRS management. Traditionally, CRS phenotypes have been divided into with or without nasal polyps depending on the presence of polyps. Although this classification does not reflect the various endotypes that are recently emerging, it is simple and easily recognized by clinicians. Other phenotypes of CRS are fungal rhinosinusitis (including invasive and noninvasive subtypes), infectious rhinosinusitis, aspirin-exacerbated respiratory disease, cystic fibrosis, pediatric CRS, and CRS associated with systemic diseases. This article reviews the diagnostic approaches and up-to-date treatment strategies for each CRS phenotype with the hope that a better understanding of endotypes will result in a more scientific understanding of phenotypes and precise, personalized treatments.
Collapse
|
19
|
Ning A, Kocharyan A, Brown WC, D'Anza B. Chronic Invasive Fungal Sinusitis With Negative Histopathology: A Diagnostic Challenge. EAR, NOSE & THROAT JOURNAL 2021; 102:319-322. [PMID: 33781123 DOI: 10.1177/0145561320973773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Although the diagnosis of chronic invasive fungal sinusitis relies chiefly on identification of invasive fungi on histology, the insidious nature of the disease can preclude detection of fungal organisms. Here, we present a case of chronic invasive fungal sinusitis with negative histopathologic findings and a definitive diagnosis made through fungal DNA detection. Clinicians should consider polymerase chain reaction an important complement to histology and culture in the diagnosis of chronic invasive fungal sinusitis.
Collapse
Affiliation(s)
- Anne Ning
- 12304Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Arminé Kocharyan
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - W Colby Brown
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Brian D'Anza
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Division of Rhinology, Allergy, and Skull Base Surgery, ENT Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
20
|
Image findings in patients with chronic invasive fungal infection of paranasal sinuses. J Neuroradiol 2021; 48:325-330. [PMID: 33639140 DOI: 10.1016/j.neurad.2021.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/09/2020] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES More clear classification of chronic invasive fungal infection of paranasal sinuses in the clinical presentation, radiologic findings, and pathology is needed. To describe the imaging findings of patients with chronic invasive fungal sinusitis (CIFS) and chronic granulomatous invasive fungal sinusitis (CGIFS). METHODS Eleven patients with CIFS or CGIFS between January 2014 and July 2019 were included in this retrospective study. The demographic, pathologic, and imaging characteristics of the included patients were reviewed by rhinologist, pathologist, and radiologist, respectively. In terms of imaging analysis, overall lesions were categorized as diffuse infiltrative and mass-forming patterns. RESULTS Among eleven patients, ten patients were aged ≥ 60 years (mean age 74.2 years) and nine had hypertension and/or diabetes mellitus. Aspergillus species were the most common pathogens (82%). Of the seven patients with CIFS, five (71%) had diffuse infiltrative patterns and two (29%) had mass-forming patterns, whereas all four patients (100%) with CGIFS had a mass forming pattern. All 11 patients showed both bony erosion and sclerosis. Almost all proven pathologic sites showed predominantly intermediate to high signal intensity on T1WI. CONCLUSIONS CIFS or CFIFS showed chronic course of rhinosinusitis in the patients with old age, imaging findings of bone erosion and sclerosis, and imaging patterns of diffuse infiltration or mass formation.
Collapse
|
21
|
Lagos AE, García-Huidobro FG, Sepúlveda V, Cruz JP, González C, Callejas CA. Determination of variables for a more accurate diagnostic approach in suspected acute invasive fungal rhinosinusitis: A non-concurrent cohort study. Clin Otolaryngol 2021; 46:775-781. [PMID: 33548105 DOI: 10.1111/coa.13734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/04/2021] [Accepted: 01/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe a group of patients with suspected acute invasive fungal rhinosinusitis (AIFRS) diagnosis, and identify factors associated with a greater risk of presenting this disease. DESIGN Non-concurrent cohort study. SETTING A single-centre non-concurrent follow-up of patients with suspected AIFRS between August 2015 and July 2018. PARTICIPANTS 50 inpatients referred due to suspected AIFRS at Hospital Clínico Universidad Católica based on the association of a predisposing factor (neutropenia/immunodeficiency/poorly controlled diabetes) with fever of unknown origin. MAIN OUTCOME MEASURE The primary outcome was AIFRS diagnosis, defined as a concordant tissue biopsy. RESULTS Acute invasive fungal rhinosinusitis was confirmed in 18% (9/50) of the evaluated patients. AIFRS was significantly associated with a positive galactomannan (P = .04), and a paranasal sinus MRI with lack of contrast enhancement (LoCE) (P = .04) orbit compromise (P = .03) or global extrasinusal extension (P = .04). LoCE and extrasinusal extension in the paranasal sinus/brain MRI were risk factors for AIFRS (OR 16; CI 1.2-210.6 and OR 12.75; CI 1.3-128.8, respectively). Conversely, a nasal endoscopy showing healthy mucosa was identified as a protective factor for AIFRS (OR 0.06; CI 0.007-0.57). CONCLUSIONS In patients with suspected AIFRS, we identified laboratory and radiologic variables associated with the disease, which may help for a more accurate diagnostic algorithm and approach in this population.
Collapse
Affiliation(s)
- Antonia E Lagos
- Department of Otolaryngology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Valeria Sepúlveda
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pablo Cruz
- Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia González
- Department of Otolaryngology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudio A Callejas
- Department of Otolaryngology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
22
|
Lee JH, Lee BD. Characteristic features of fungus ball in the maxillary sinus and the location of intralesional calcifications on computed tomographic images: A report of 2 cases. Imaging Sci Dent 2021; 50:377-384. [PMID: 33409149 PMCID: PMC7758261 DOI: 10.5624/isd.2020.50.4.377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022] Open
Abstract
This report presents 2 cases of sinus fungus ball and describes the characteristic radiographic features of fungus ball in the maxillary sinus. Two female patients, aged 62 and 40 years, sought consultations at a dental hospital for the treatment of dental implants and tooth pain, respectively. Panoramic radiography and small field-of-view (FOV) cone-beam computed tomography (CBCT) did not provide detailed information for the radiographic diagnosis of fungus ball due to the limited images of the maxillary sinus. Additional paranasal sinus computed tomographic images showed the characteristic features of fungus ball, such as heterogeneous opacification and intralesional calcification of the maxillary sinus. The calcified materials of the fungus balls were located in the middle and superior regions of the maxillary sinus. It is necessary to use large-FOV CBCT for the detection of calcified materials in the upper maxillary sinus to confirm the diagnosis of fungus ball.
Collapse
Affiliation(s)
- Jae-Hoon Lee
- Department of Otolaryngology, Institute of Wonkwang Medical Science, School of Medicine, Wonkwang University, Iksan, Korea
| | - Byung-Do Lee
- Department of Oral and Maxillofacial Radiology and Research Institute of Dental Education, College of Dentistry, Wonkwang University, Iksan, Korea
| |
Collapse
|
23
|
Harreld JH, Kaufman RA, Kang G, Maron G, Mitchell W, Thompson JW, Srinivasan A. The use of imaging to identify immunocompromised children requiring biopsy for invasive fungal rhinosinusitis. Pediatr Blood Cancer 2020; 67:e28676. [PMID: 32860662 DOI: 10.1002/pbc.28676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Children with severe immunocompromise due to cancer therapy or hematopoietic cell transplant are at risk both for potentially lethal invasive fungal rhinosinusitis (IFRS), and for complications associated with gold-standard biopsy diagnosis. We investigated whether early imaging could reliably identify or exclude IFRS in this population, thereby reducing unnecessary biopsy. METHODS We reviewed clinical/laboratory data and cross-sectional imaging from 31 pediatric patients evaluated for suspicion of IFRS, 19 without (age 11.8 ± 5.4 years) and 12 with proven IFRS (age 11.9 ± 4.6 years). Imaging examinations were graded for mucosal thickening (Lund score), for fungal-specific signs (FSS) of bone destruction, extra-sinus inflammation, and nasal mucosal ulceration. Loss of contrast enhancement (LoCE) was assessed separately where possible. Clinical and imaging findings were compared with parametric or nonparametric tests as appropriate. Diagnostic accuracy was assessed by receiver operating characteristic (ROC) analysis. Positive (+LR) and negative likelihood ratios (-LR) and probabilities were calculated. RESULTS Ten of 12 patients with IFRS and one of 19 without IFRS had at least one FSS on early imaging (83% sensitive, 95% specific, +LR = 15.83, -LR = 0.18; P < .001). Absolute neutrophil count (ANC) ≤ 200/mm3 was 100% sensitive and 58% specific for IFRS (+LR = 2.38, -LR = 0; P = .001). Facial pain was the only discriminating symptom of IFRS (P < .001). In a symptomatic child with ANC ≤ 200/m3 , the presence of at least one FSS indicated high (79%) probability of IFRS; absence of FSS suggested low (<4%) probability. CONCLUSION In symptomatic, severely immunocompromised children, the presence or absence of fungal-specific imaging findings may effectively rule in or rule out early IFRS, potentially sparing some patients the risks associated with biopsy.
Collapse
Affiliation(s)
- Julie H Harreld
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Robert A Kaufman
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Guolian Kang
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Gabriela Maron
- Department of Infectious Disease, St Jude Children's Research Hospital, Memphis, Tennessee
| | - William Mitchell
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jerome W Thompson
- Department of Otolaryngology, University of Tennessee Health Sciences Center; Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Ashok Srinivasan
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, Tennessee
| |
Collapse
|
24
|
Pérez-Sayáns M, Suárez Peñaranda JM, Quintanilla JAS, Chamorro Petronacci CM, García AG, Carrión AB, Vila PG, Sánchez YG. Clinicopathological features of 214 maxillary sinus pathologies. A ten-year single-centre retrospective clinical study. Head Face Med 2020; 16:24. [PMID: 33050926 PMCID: PMC7552481 DOI: 10.1186/s13005-020-00239-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/01/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diagnosis of maxillary sinus pathology must include the clinical radiological study (CRS) and histopathological analysis. The aim of this study is 1) to describe the clinicopathological features of maxillary sinus lesions, obtained successively in a single medical centre over the last 10 years and 2) to determine the sensitivity and specificity for the diagnosis of malignant lesions based exclusively on the CRS. METHODS It is a single-centre observational retrospective clinical study on patients who attended the University Hospital Complex of Santiago de Compostela (CHUS) with sinus pathologies during the period of 2009-2019. RESULTS The sample consisted of 133 men (62.1%) and 81 women (37.9%), with an average age of 46.9 years (SD = 18.8). In terms of frequency, the most frequent pathology was the unspecified sinusitis (44.4%), followed by polyps (18.2%), malignant tumours (9.8%), inverting papilloma (7.5%), fungal sinusitis (4.7%), cysts (3.7%), benign tumours (2.3%), mucocele (2.3%) and other lesions (1.9%). Cysts and benign tumours were diagnosed earliest Vs malignant tumours (65.2 years (SD = 16.1)) were diagnosed the latest (p < 0.001). Based only on the CRS for malignancies, diagnostic indexes were 71.4% sensitivity and 97.9% specificity, with a Kappa value of 0.68 with (p < 0.001). CONCLUSION Maxillary sinus pathology is very varied with therapeutic and prognostic repercussions. CRS is sometimes insufficient and histopathological confirmation is essential.
Collapse
Affiliation(s)
- Mario Pérez-Sayáns
- Health Research Institute of Santiago (IDIS), Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain.
| | - José M Suárez Peñaranda
- Pathological Anatomy Service, University Hospital Complex of Santiago (CHUS), C.P. 15782, Santiago de Compostela, Spain
| | - Juan Antonio Suárez Quintanilla
- Area of Human Anatomy and Embryology, Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain
| | - Cintia M Chamorro Petronacci
- Health Research Institute of Santiago (IDIS), Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain
| | - Abel García García
- Health Research Institute of Santiago (IDIS), Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain
| | - Andrés Blanco Carrión
- Health Research Institute of Santiago (IDIS), Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain
| | - Pilar Gándara Vila
- Health Research Institute of Santiago (IDIS), Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, C.P. 15782, Santiago de Compostela, Spain
| | | |
Collapse
|
25
|
Lagos A, Ferrada S, Muñoz T, Maul X, Finkelstein A, González C, Fonseca X, Callejas C. 10-year Experience in Patients Operated for Acute Invasive Fungal Rhinosinusitis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
26
|
Orman G, Kralik SF, Desai N, Meoded A, Vallejo JG, Huisman TAGM, Tran BH. Imaging of Paranasal Sinus Infections in Children: A Review. J Neuroimaging 2020; 30:572-586. [PMID: 32472739 DOI: 10.1111/jon.12737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022] Open
Abstract
Paranasal sinuses (PNS) infections are common in children. They may cause common and well-known complications, but also, unusual and potentially devastating complications. Diagnosing PNS infections and complications in children requires knowledge of the unique anatomy of the nasal cavity and the PNS. In fetal life, nasal mucosa evaginations into the lateral nasal walls initiate the development of the PNS. The PNS continue to develop after birth and complete their maturation and pneumatization at different ages during childhood which makes the pattern of PNS infections determined by patient age. Complications are caused by direct spread of the infection to the orbit, face, intracranial or osseous structures or hematogenous spread of the infection to the intracranial structures. Emergent imaging studies are often necessary in the evaluation of the complications in pediatric patients when the symptoms persist for 10 days and/or if there is evidence of intracranial or orbital complications. In addition, immunocompromised children are especially vulnerable to developing unusual complications. Computed tomography (CT) is excellent for determining whether there is intraorbital extension of PNS disease. However, when the infection approaches the orbital apex, a magnetic resonance imaging (MRI) study with contrast is necessary to assess spread into the cavernous sinus and the intracranial compartment. The goal of this manuscript is to review and characterize imaging findings of PNS infections using CT and MRI allowing determination of the extent of PNS infections and their common and unusual complications in children. In addition, a summary of the development of the normal PNS is provided.
Collapse
Affiliation(s)
- Gunes Orman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, TX
| | - Stephen F Kralik
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, TX
| | - Nilesh Desai
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, TX
| | - Avner Meoded
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, TX
| | - Jesus G Vallejo
- Department of Pediatrics, Section of Infectious Diseases, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | | | - Brandon H Tran
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, TX
| |
Collapse
|
27
|
Eissa L, Eid M, Razek AAKA. MR and CT imaging features of sino-nasal organized hematomas. Oral Radiol 2020; 37:297-304. [PMID: 32462337 DOI: 10.1007/s11282-020-00450-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/17/2020] [Indexed: 11/26/2022]
Abstract
AIM To describe the MR and CT imaging features of organized hematomas [OH]. METHODS A retrospective analysis of MR imaging and CT of eight patients [6 male, 2 females; age range is 6-86 years] with pathological proven OH was performed. Routine contrast MR and CT scan were done for all patients, and diffusion-weighted imaging and dynamic contrast CT were done for only five patients. Imaging analysis was done for the signal intensity, the enhancement pattern at MR imaging, the ADC value at DWI, bone remodeling at CT, and the neo-vascularization at dynamic contrast CT. RESULTS OH revealed T2 hypo-intense of the matrix in all patients with complete [n = 3] and incomplete [n = 5] marginal hypo-intensity rim. The lesions revealed a frond-like pattern of contrast enhancement of the central part of the lesion that associated with a peripheral rim of contrast enhancement. OH revealed unrestricted diffusion with high ADC value [1.7-2.5 × 10-3 cm2/s] in 5 patients. CT scan showed geographic bone remodeling and thinning of the nasal turbinates, and the sinus wall and contrast CT showed neo-vascularization with frond-like branching arteries of the central part of the lesions in five patients. CONCLUSION We conclude that MR and CT imaging findings can help in the diagnosis of OH.
Collapse
Affiliation(s)
- Lamya Eissa
- Department of Diagnostic and Interventional Radiology, Alexandria Faculty of Medicine, Alexandria, 21131, Egypt
| | - Mohamed Eid
- Department of Diagnostic and Interventional Radiology, Alexandria Faculty of Medicine, Alexandria, 21131, Egypt
| | | |
Collapse
|
28
|
Lagos A, Ferrada S, Muñoz T, Maul X, Finkelstein A, González C, Fonseca X, Callejas C. 10-year experience in patients operated for acute invasive fungal rhinosinusitis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71:303-308. [PMID: 32402378 DOI: 10.1016/j.otorri.2019.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/07/2019] [Accepted: 11/17/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Acute invasive fungal rhinosinusitis (AIFRS) is rare but has high mortality. It is more frequent in immunocompromised patients with multiple comorbidities, which make their management more difficult. The aim of this study is to describe a cohort of patients operated due to AIFRS, their clinical characteristics, mortality, aetiological agent and efficacy of diagnostic tests. MATERIAL AND METHOD Non-concurrent prospective study of patients with AIFRS who were operated between 2005 and 2015 in our centre. RESULTS Thirty-two patients were included, 62.5% (20/32) men, with an average age of 39.4 years (16-65 years). Overall mortality was 71.9%; acute mortality 46.9% and late mortality 25%. Haematological malignancies were the most common underlying disease, present in 84.4% (27/32) of cases, followed by diabetes mellitus in 9.4% (3/32). On diagnosis, 62.5% (20/32) of patients were neutropenic, 80% (16/20) of them with febrile neutropenia. Fever was the most frequent symptom, present in 65.6% (21/32) of patients, followed by facial pain or headache in 53.1% (17/32). Aspergillus was identified in 37.5% (12/32) of cases and Rhizopus in 31.3% (10/32). There was no association between the analysed variables and increased risk of mortality. CONCLUSIONS AIFRS is an aggressive disease with a high mortality rate, therefore a timely diagnosis is fundamental. It is necessary to optimise suspicion criteria for an early diagnosis in order to improve the prognosis.
Collapse
Affiliation(s)
- Antonia Lagos
- Departamento de Otorrinolaringología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Ferrada
- Departamento de Otorrinolaringología, Hospital Regional de Temuco, Temuco, Chile
| | - Tamara Muñoz
- Departamento de Otorrinolaringología, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - Ximena Maul
- Departamento de Otorrinolaringología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Finkelstein
- Departamento de Otorrinolaringología, Clínica Alemana de Santiago, Santiago, Chile
| | - Claudia González
- Departamento de Otorrinolaringología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ximena Fonseca
- Departamento de Otorrinolaringología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudio Callejas
- Departamento de Otorrinolaringología, Pontificia Universidad Católica de Chile, Santiago, Chile.
| |
Collapse
|
29
|
Harreld JH, Kaufman RA, Kang G, Maron G, Mitchell W, Thompson JW, Srinivasan A. Utility of Pre-Hematopoietic Cell Transplantation Sinus CT Screening in Children and Adolescents. AJNR Am J Neuroradiol 2020; 41:911-916. [PMID: 32273266 DOI: 10.3174/ajnr.a6509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 03/03/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE The clinical benefit of pre-hematopoietic cell transplantation sinus CT screening remains uncertain, while the risks of CT radiation and anesthesia are increasingly evident. We sought to re-assess the impact of screening sinus CT on pretransplantation patient management and prediction of posttransplantation invasive fungal rhinosinusitis. MATERIALS AND METHODS Pretransplantation noncontrast screening sinus CTs for 100 consecutive patients (mean age, 11.9 ± 5.5 years) were graded for mucosal thickening (Lund-Mackay score) and for signs of noninvasive or invasive fungal rhinosinusitis (sinus calcification, hyperattenuation, bone destruction, extrasinus inflammation, and nasal mucosal ulceration). Posttransplantation sinus CTs performed for sinus-related symptoms were similarly graded. Associations of Lund-Mackay scores, clinical assessments, changes in pretransplantation clinical management (additional antibiotic or fungal therapy, sinonasal surgery, delayed transplantation), and subsequent development of sinus-related symptoms or invasive fungal rhinosinusitis were tested (exact Wilcoxon rank sums, Fisher exact test, significance P < .05). RESULTS Mean pretransplantation screening Lund-Mackay scores (n = 100) were greater in patients with clinical symptoms (8.07 ± 6.00 versus 2.48 ± 3.51, P < .001) but were not associated with pretransplantation management changes and did not predict posttransplantation sinus symptoms (n = 21, P = .47) or invasive fungal rhinosinusitis symptoms (n = 2, P = .59). CONCLUSIONS Pre-hematopoietic cell transplantation sinus CT does not meaningfully contribute to pretransplantation patient management or prediction of posttransplantation sinus disease, including invasive fungal rhinosinusitis, in children. The risks associated with CT radiation and possible anesthesia are not warranted in this setting.
Collapse
Affiliation(s)
- J H Harreld
- From the Departments of Diagnostic Imaging (J.H.H., R.A.K.),
| | - R A Kaufman
- From the Departments of Diagnostic Imaging (J.H.H., R.A.K.)
| | | | | | - W Mitchell
- Bone Marrow Transplantation and Cellular Therapy (W.M., A.S.), and
| | - J W Thompson
- Surgery (J.W.T.), St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Otolaryngology (J.W.T.), University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - A Srinivasan
- Bone Marrow Transplantation and Cellular Therapy (W.M., A.S.), and
| |
Collapse
|
30
|
Li Z, Wang X, Jiang H, Qu X, Wang C, Chen X, Chong VFH, Zhang L, Xian J. Chronic invasive fungal rhinosinusitis vs sinonasal squamous cell carcinoma: the differentiating value of MRI. Eur Radiol 2020; 30:4466-4474. [PMID: 32279114 DOI: 10.1007/s00330-020-06838-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/07/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate MRI features in discriminating chronic invasive fungal rhinosinusitis (CIFRS) from sinonasal squamous cell carcinomas (SNSCC). METHODS MRI findings of 33 patients with CIFRS and 47 patients with SNSCC were retrospectively reviewed and compared. Multivariate logistic regression analysis was performed to identify significant imaging features in distinguishing between CIFRS and SNSCC. The ROC curves and the AUC were used to evaluate diagnostic performance. RESULTS There were significant differences in cavernous sinus involvement (p < 0.001), sphenoid sinus involvement (p < 0.001), meningeal involvement (p = 0.024), T2 signal intensity (p = 0.006), and enhancement pattern (p < 0.001) between CIFRS and SNSCC. Multivariate logistic regression analysis identified cavernous sinus involvement (odds ratio [OR] = 0.06, 95% confidence interval [95% CI] = 0.02-0.20) and sphenoid sinus involvement (OR = 0.14, 95% CI = 0.05-0.45) as significant indicators for CIFRS and T2 isointensity to gray matter (OR = 4.44, 95% CI = 1.22-16.22) was a significant indicator for SNSCC. ROC curve analysis showed the AUC from a combination of three imaging features was 0.95 in differentiating CIFRS and SNSCC. CONCLUSIONS MRI showed significant differences between CIFRS and SNSCC features. In immunocompromised patients, a sinonasal hypointense mass on T2WI with septal enhancement or loss of contrast enhancement, and involvement of cavernous sinus, sphenoid sinus, and meninges strongly suggest CIFRS. KEY POINTS • Chronic invasive fungal rhinosinusitis (CIFRS) is often difficult to distinguish from sinonasal squamous cell carcinomas (SNSCC) in clinical practice. • Cavernous sinus and sphenoid sinus involvement appear to be significant indicators for CIFRS. T2 isointensity to gray matter appears to be a significant indicator for SNSCC. • Loss of contrast enhancement and septal enhancement can be used to distinguish CIFRS from SNSCC with a high degree of specificity.
Collapse
Affiliation(s)
- Zheng Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, China
| | - Xiao Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, China
| | - Hong Jiang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, China
| | - Xiaoxia Qu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, China
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Xiaohong Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Vincent Fook-Hin Chong
- Department of Diagnostic Imaging, National University Hospital, National University of Singapore, Singapore, 117094, Singapore
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China. .,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China. .,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, No. 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, China.
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, No. 1, DongJiaoMinXiang Street, DongCheng District, Beijing, 100730, China.
| |
Collapse
|
31
|
Liu X, Liu C, Wei H, He S, Dong S, Zhou B, Zhang L, Li Y. A retrospective analysis of 1,717 paranasal sinus fungus ball cases from 2008 to 2017. Laryngoscope 2019; 130:75-79. [PMID: 31466130 DOI: 10.1002/lary.27869] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/20/2019] [Accepted: 01/28/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Xin Liu
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
| | - Chengyao Liu
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
| | - Hongzheng Wei
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
| | - Shuai He
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
| | - Shouxiang Dong
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
| | - Bing Zhou
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
| | - Luo Zhang
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
- Beijing Key Laboratory of Nasal DiseasesBeijing Institute of Otolaryngology Beijing China
| | - Yunchuan Li
- Department of Otolaryngology–Head and Neck SurgeryBeijing Tongren Hospital, Capital Medical University Beijing China
| |
Collapse
|
32
|
Abstract
Fungal rhinosinusitis (FRS), once considered a rare disease, has seen a steep rise in incidence in recent times. This global rise in the burden of fungal disease is a consequence of an increment in the population with weakened immune systems. Increased life expectancy with rise in conditions like diabetes mellitus, medical advancements with invasive interventions, use of immunosuppressive drugs and chemo-radiotherapy all lead to unique risk situations. The situation becomes more alarming with the fact that there has been a significant rise in cases in immune-competent hosts with no predisposing factors. FRS represents a wide spectrum of disease ranging from the mild form of superficial colonization, allergic manifestations to life threatening extensive invasive disease. The categorization of disease into acute and chronic and invasive or noninvasive is important factor with implications in disease management and prognosis and this has been emphasized greatly in recent years. Diagnosis of FRS has been a challenge as the presenting clinical signs and symptoms and radiographic manifestations are often nonspecific. Definitive diagnosis requires direct fungi identification and hence culture and microscopic examination remain the gold standard. Availability of advanced and rapid diagnostic techniques is rare in majority of developing nations. Therapeutic dilemmas are another aspect of the management of FRS as in spite of the availability of new antifungal drugs, treatment is often empirical due to non-availability of early diagnosis, rapid disease progression and high costs of antifungal drugs. A description of the different types of FRS, their diagnosis and management has been presented in this review.
Collapse
Affiliation(s)
- Virendra Singh
- Department of Oral and maxillofacial Surgery, PGIDS, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana 124001 India
| |
Collapse
|
33
|
Popolizio T, Perri M, Balzano RF, Al-Badayneh B, Izzo R, Graziano P, Guglielmi G. Isolated fungus ball in sphenoid sinus: tips and pitfalls of T 1 hyperintense lesions. BJR Case Rep 2018; 4:20170081. [PMID: 30363174 PMCID: PMC6159120 DOI: 10.1259/bjrcr.20170081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 12/13/2022] Open
Abstract
Isolated sphenoid sinus fungus ball is a very rare condition. CT is the most used imaging investigation for diagnosis. In some cases, MRI may provide further information to evaluate the extracompartmental invasion. We report the case of an elderly female patient who presented with headache and a soft tissue mass filling the right sphenoid sinus on CT, misdiagnosed as simple sinusitis. After 1 year, with recrudescence of symptoms, brain MRI showed a hyperintense soft tissue mass on T1 weighted images within the right sphenoidal sinus; a new CT examination revealed calcifications within the mass. Surgical histological examination showed fungus ball. Fungal ball should be included in the differential diagnosis of T1 hyperintense lesions in the sphenoid sinus.
Collapse
Affiliation(s)
- Teresa Popolizio
- Department of Radiology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Puglia, Italy
| | - Marco Perri
- Department of Radiology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Puglia, Italy
| | - Rosario Francesco Balzano
- Department of Radiology, Università degli Studi di Foggia Scuole di Specializzazione di Area Medica, Foggia, Puglia, Italy
| | - Bilal Al-Badayneh
- Department of Radiology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Puglia, Italy
| | - Roberto Izzo
- Department of Radiology, Ospedale Cardarelli, Naples, Italy
| | - Paolo Graziano
- Department of Hemathology and Medical Oncology, Unit of Pathology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Puglia, Italy
| | | |
Collapse
|