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Ermilov OV, Shutov VI, Tret'yakov AY, Nikonorova LB, Bocharova MA, Khabibullin RR. [Mycosis of the maxillary sinus]. Vestn Otorinolaringol 2023; 88:78-85. [PMID: 37450396 DOI: 10.17116/otorino20228803178] [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: 07/18/2023]
Abstract
In the structure of morbidity and mortality has significantly increased the role of mycoses. The increase in their spread is due not only to the improvement of the quality of diagnosis, but also the emergence of new strains resistant to previously used antifungal drugs, a significant change in the immune status of the population. In addition to environmental factors, it is important to introduce modern methods of treatment that increase survival in the whole spectrum of diseases. This situation can't affect the structure of diseases of ENT organs: the number of mycoses has increased significantly in recent decades. The issues of diagnosis and treatment of mycoses of the paranasal sinuses continue to be an urgent problem of otorhinolaryngology. The reason for this is a number of difficulties associated with the diagnosis: the absence of specific symptoms of the disease, the possible secondary nature of the attachment of fungal infection against the background of bacterial lesions, transient carrier of infection, technical difficulties and errors in the study of biomaterial with insufficient standardization of microbiological methods. Our report is devoted to the clinical case of aspergillosis of the maxillary sinus and a review of the literature on this issue, which in our opinion can be very interesting to the medical community.
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Affiliation(s)
- O V Ermilov
- Federal State Autonomous Educational Institution of Higher Education «Belgorod National Research University», Belgorod, Russia
- Belgorod Region Clinical Hospital of Saint Ioasaf, Belgorod, Russia
| | - V I Shutov
- Federal State Autonomous Educational Institution of Higher Education «Belgorod National Research University», Belgorod, Russia
- Belgorod Region Clinical Hospital of Saint Ioasaf, Belgorod, Russia
| | - A Yu Tret'yakov
- Federal State Autonomous Educational Institution of Higher Education «Belgorod National Research University», Belgorod, Russia
| | - L B Nikonorova
- Belgorod Region Clinical Hospital of Saint Ioasaf, Belgorod, Russia
| | - M A Bocharova
- Belgorod Region Clinical Hospital of Saint Ioasaf, Belgorod, Russia
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Tadros D, Tomoum MO, Shafik HM. Orbital Complications of Acute Invasive Fungal Rhinosinusitis: A New Challenge in the COVID-19 Convalescent Patients. Clin Ophthalmol 2022; 16:4011-4019. [PMID: 36514418 PMCID: PMC9741827 DOI: 10.2147/opth.s391188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose Increased incidence of acute invasive fungal rhinosinusitis (AIFR) in the setting of COVID-19 is undeniable. This can be attributed to its effect on innate immunity and extensive use of corticosteroids. The goal of our study was to assess the orbital complications of AIFR and its management in the COVID-19 convalescent patients. Methods Our longitudinal prospective study included 45 patients with orbital complications of AIFR in recently recovered COVID-19 patients. We performed otorhinolaryngological, ophthalmological, and neurological examinations to monitor the manifestations of the disease. Computed tomography and contrast enhanced magnetic resonance imaging were performed to detect the extent of infection. Antifungal medications, surgical intervention, and general condition management were all provided to all the patients. Results We reported pre-septal cellulitis, orbital cellulitis, and orbital apex syndrome in 18, 13, and 10 patients, respectively. Four patients had cavernous sinus thrombosis. Mucormycosis and Aspergillus species were detected in 80% and 11.11% of our patients, respectively, while the mixed infection was found in 8.88% of our patients. Diabetes mellitus was the most common cause of immunocompromise (95.55% of our patients). Orbital pain and ophthalmoplegia were the most common ocular manifestations, followed by proptosis and relative afferent pupillary defect. All patients underwent surgical intervention, except for one patient who was unfit for surgery. One patient had orbital exenteration. The ophthalmological manifestations were reversible in cases of orbital and pre-septal cellulitis. The overall survival rate was 66.67%. Conclusion Early diagnosis and treatment of AIFR can decrease the morbidity and mortality rate of affected patients.
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Affiliation(s)
- Dina Tadros
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt,Correspondence: Dina Tadros, Tanta University Hospital, Department of Ophthalmology, El-Geesh Street, Tanta, El-Gharbia, 31515, Egypt, Tel +201224093354, Email
| | - Mohamed O Tomoum
- Department of Otorhinolaryngology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Heba M Shafik
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Bracanovic D, Janovic A, Antic S, Rajkovic K, Bracanovic M, Tomic Spiric V, Dragutinovic N, Jadzic J, Barac A. "CT and CT image-based texture image analysis in radiological diagnostics of allergic fungal rhinosinusitis". Mycoses 2022; 65:551-559. [PMID: 35293035 DOI: 10.1111/myc.13438] [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: 12/04/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This prospective study is focused on evaluating radiological properties of AFRS. We analysed specific CT features related to the presence of AFRS, as well as explored the possible usefulness of the texture image analysis (TIA) as an additional diagnostical parameter. METHODS The CT images of maxillary sinuses of 37 adult patients diagnosed with chronic rhinosinusitis were analysed for homogeneity, high-attenuation areas, density of the soft tissue mass, bony wall thickness and density. TIA included assessment of uniformity, contrast, homogeneity, and entropy of sinus contetnt. RESULTS In the F+ group soft tissue mass was significantly more non-homogeneous, high-attenuation areas were more prevalent, while soft tissue densities were higher. The sinus wall showed a tendency toward decreased thickness and significantly higher density in the F+ group. Among TIA parameters only homogeneity was significantly lower in the F+ group. CONCLUSIONS Presence of fungi should be suspected when the sinus is filled with a non-homogenous soft tissue content of a high CT density not necessarily presented as clearly visible hyperattenuation material. Additional criteria in radiological diagnostics of AFRS should encompass assessment of sinus bony wall density. TIA may serve as a tool for quantitative assessment of subjective CT features such as homogeneity of the soft tissue mass for investigative purposes. However, other TIA parameters showed limited potential.
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Affiliation(s)
- Djurdja Bracanovic
- Department of Diagnostic Radiology, Faculty of Dental Medicine, University of Belgrade, 6 Rankeova, 11 000, Belgrade, Serbia
| | - Aleksa Janovic
- Department of Diagnostic Radiology, Faculty of Dental Medicine, University of Belgrade, 6 Rankeova, 11 000, Belgrade, Serbia
| | - Svetlana Antic
- Department of Diagnostic Radiology, Faculty of Dental Medicine, University of Belgrade, 6 Rankeova, 11 000, Belgrade, Serbia
| | - Katarina Rajkovic
- High Technical and Technological School for Professional Studies, Krusevac, Serbia
| | - Milos Bracanovic
- Clinic for emergency surgery, Clinical Center of Serbia, 2 Pasterova, 11 000, Belgrade, Serbia
| | - Vesna Tomic Spiric
- Clinic for Allergology and Immunology, Clinical Center of Serbia, 26 dr Koste Todorovica, 11 000, Belgrade, Serbia
| | - Natasa Dragutinovic
- Department of Gastroenterology, Hepatology and GI Endoscopy, University Children's Hospital, Serbia
| | - Jelena Jadzic
- Laboratory for Anthropology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Dr. Subotica no. 4/2, Belgrade, Serbia
| | - Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, 16 Bulevar Oslobodjenja, 11 000, Belgrade, Serbia
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Adulkar NG, Radhakrishnan S, Vidhya N, Kim U. Invasive sino-orbital fungal infections in immunocompetent patients: a clinico-pathological study. Eye (Lond) 2019; 33:988-994. [PMID: 30765886 DOI: 10.1038/s41433-019-0358-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 05/12/2018] [Accepted: 10/11/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Invasive sino-orbital fungal infections in immunocompetent patients are a rare clinical entity; the diagnosis and management of which is challenging. We present a large case series of invasive sino-orbital fungal granulomas in patients without pre-existing systemic immunocomprimising condition. DESIGN Retrospective case series. PARTICIPANTS Twenty cases of invasive sino-orbital/naso-orbital fungal granulomas in immunocompetent individuals. METHODS We retrospectively analyzed all patients with orbital fungal granuloma who were treated at a tertiary referral eye center in South India between January 2005 and December 2012. Histopathologic confirmation of tissue invasion by fungal elements and presence of granulomatous inflammation was established in all cases included in the study. MAIN OUTCOME MEASURES Relief of patient symptoms, resolution/no progression of disease on orbital imaging, ocular, and vision salvage were the treatment outcomes studied. RESULTS Twenty patients (11 male and 9 female) were studied. Mean age of patients was 47.4 years ranging from 24-65 years. Aspergillus was the causative fungus in 18 cases while 2 were cases of mucormycosis. Surgical debulking of the orbital disease was performed in 7 patients. Exenteration was performed in 2 patients to prevent spread to the CNS. Medical therapy consisted of oral itraconazole in all patients and intravenous amphotericin B was administered in 2 patients. Average duration of medical therapy required to achieve relief from symptoms was 6-8 months. Recurrences are common and long-term follow-up is essential. CONCLUSIONS Orbital fungal infections are challenging in terms of both diagnosis and treatment. Debulking along with prolonged antifungal therapy seems to be effective in controlling the infection.
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Affiliation(s)
| | | | - N Vidhya
- Department of Orbit, Oculoplasty & Ocular Oncology, Aravind Eye Hospital, Madurai, India
| | - Usha Kim
- Department of Orbit, Oculoplasty & Ocular Oncology, Aravind Eye Hospital, Madurai, India
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Ho CF, Lee TJ, Wu PW, Huang CC, Chang PH, Huang YL, Lee YL, Huang CC. Diagnosis of a maxillary sinus fungus ball without intralesional hyperdensity on computed tomography. Laryngoscope 2018; 129:1041-1045. [PMID: 30582161 DOI: 10.1002/lary.27670] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/30/2018] [Accepted: 10/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Maxillary sinus fungus ball (MSFB) is the most common type of noninvasive fungal rhinosinusitis. Surgical removal of the ball achieves good outcomes. Making a rapid and accurate diagnosis is important to avoid unnecessary medical therapy. Intralesional hyperdensity (IH) on computed tomography (CT) is reportedly a good indicator. The aim of this study was to evaluate the diagnostic features of MSFB without IH on preoperative CT images. STUDY DESIGN Retrospective database review. METHODS Two hundred fifty-eight patients with histopathological evidence of a sinus fungal ball were retrospectively investigated. Forty-seven of 222 patients with MSFB did not show IH on preoperative CT images and were enrolled in the MSFB group. Forty-one patients with unilateral nonfungal chronic rhinosinusitis were enrolled in a control group. CT features previously reported to have diagnostic significance were evaluated. RESULTS Sclerosis of the lateral sinus wall, erosion of the inner sinus wall, and irregular surface of the material were significantly more common in the MSFB group than in the control group. In the subgroup of patients with total opacification in the maxillary sinus, the sensitivity, specificity, and positive and negative predictive values for erosion of the inner sinus wall were more than 90%. In the subgroup with partial opacification, the sensitivity, specificity, and positive predictive value of an irregular surface of the material were more than 80%. CONCLUSIONS We have devised an algorithm to help diagnose MSFB without IH on preoperative CT images. Use of this algorithm would improve the diagnostic accuracy and ensure appropriate treatment. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1041-1045, 2019.
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Affiliation(s)
- Che-Fang Ho
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
| | - Ta-Jen Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Pei-Wen Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
| | - Chi-Che Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,the Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hung Chang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,the Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Lin Huang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yueh-Lin Lee
- Department of Radiology, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
| | - Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,the Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Abstract
Objectives: In the paranasal sinus fungal ball (SFB), changes that occur in the underlying bone have not been well described. Recently, bacterial coinfection has been reported in patients with paranasal SFB. We evaluated whether bone changes occur in patients with unilateral maxillary SFB, and also how bacteria in an SFB affect the bony wall of the sinus. Methods: A retrospective study of patients with a unilateral maxillary SFB undergoing endoscopic sinus surgery was conducted from July 2009 to December 2015. Preoperative computed tomography images of the patients were reviewed. Wall thickness (WT) and wall density (WD) of the diseased sinus were measured and compared to the normal sinus. Specimens of the sinus aspirates were obtained during surgery for aerobic and anaerobic cultures. Results: Forty-three patients were included (mean, 55.7 ± 12.8 years). Thirty-one cultures (72.1%) were positive for bacteria. Thickening was evident in the anterior, lateral, and posterior walls of the diseased sinus. The average WT was 1.69 ± 0.45 mm on the diseased sinus and 1.14 ± 0.31 mm on the normal sinus (P < 0.001). In the diseased sinus, the difference in the average WT between the culture-positive and culture-negative groups was not significant (P = 0.44). The average WD on the diseased sinus was higher than that on the normal sinus (P < 0.001). Conclusions: Osteitic change occurred in most patients with a unilateral maxillary SFB. The presence of bacteria in sinus secretions does not greatly affect the development of osteitic changes in unilateral maxillary SFB.
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Seven cases of localized invasive sino-orbital aspergillosis. Jpn J Ophthalmol 2017; 61:179-188. [PMID: 28097453 DOI: 10.1007/s10384-016-0494-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe the clinical manifestations and prognoses in 7 patients with invasive sino-orbital aspergillosis (ISOA). METHODS This was a retrospective study of consecutive patients who were diagnosed as having ISOA at the Gifu University Hospital and Gifu Municipal Hospital between January 1993 and December 2015. Data were collected on demographics, initial manifestations, examination findings, treatments, clinical course, and outcomes. RESULTS The median age of the 7 patients with ISOA was 68 years; 5 of them had diabetes. The initial symptoms were reduced blurred vision (57%), unilateral headaches (43%), unilateral abnormal sensations or numbness of the periorbital area (43%), and external ophthalmoplegia (43%). The medical department that the patients first visited was the ophthalmology department in 57% of the cases. The initial CT showed bone destruction in 71% and calcification in 14% of the patients. Six of the 7 cases were misdiagnosed. The definitive diagnosis of ISOA was made by histopathologic examinations of the biopsy specimens, with an average of 2.6 biopsies. All patients received aggressive antifungal treatments after the diagnosis. However, the final visual outcome was no light perception in 86% and death related to the ISOA in 43% of the patients. Patients who were older at the onset had lower survival rates. CONCLUSIONS The prognosis for patients with ISOA is poor in terms of both vision and life. Ophthalmologists are often the first examiner. ISOA should be considered in the differential diagnosis for patients with a gradually progressive orbital mass, unilateral headaches, numbness of the periorbital area, and a decrease in visual acuity of unknown origin.
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Ng TY, Wang JY, Tsai MH, Lin CC, Tai CJ, Ng YK. Hyperdense findings in sinus computed tomography of chronic rhinosinusitis. Int Forum Allergy Rhinol 2015; 5:1181-4. [PMID: 26338357 DOI: 10.1002/alr.21635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 07/15/2015] [Accepted: 07/28/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Our study investigated the diagnostic value of the mineralization findings and high-density secretion features of sinus computed tomography (CT) images in cases of chronic rhinosinusitis (CRS) compared to histopathology and operative findings. METHODS This was a prospective cohort study of 193 patients consecutively enrolled for endoscopic sinus surgery (ESS). Group 1 had mineralization in the sinus; group 2 had high-density secretions in the sinus but no mineralization; group 3 lacked both high-density secretions and evidence of mineralization. Intergroup comparisons were performed for histopathology (especially presence of fungus ball), CT scores, and gross operative appearance. RESULTS Histopathologic evidence of fungus ball (FB) compared to presence of CT findings was significantly different between the groups, with the following percentages of patients demonstrating FB presence: 33% of group 1 (CT mineralization) (n = 48); 4% of group 2 (CT hyperdensity) patients (n = 25); and 2% of group 3 (no mineralization, no hyperdensity) patients (n = 120) (p < 0.05). Operative findings did not necessarily correlate with CT findings and all groups demonstrated varying amounts of dry cheesy (DCM) or wet clay-like (WCLM) material, though this was slightly higher in groups 1 and 2. CONCLUSION A preoperative survey of sinus mineralization and high-density secretion features observed with CT was predictive of operative findings and histopathological results indicating a sinus FB.
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Affiliation(s)
- Teik-Ying Ng
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Ming-Hsui Tsai
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Chao-Chun Lin
- School of Medicine, China Medical University, Taichung, Taiwan.,Department of Radiology, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Jaan Tai
- Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan.,Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Yon-Keat Ng
- Department of Pharmacy, Changhua Christian Hospital, Chang Hua, Taiwan
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Chen JC, Ho CY. The significance of computed tomographic findings in the diagnosis of fungus ball in the paranasal sinuses. Am J Rhinol Allergy 2012; 26:117-9. [PMID: 22487287 DOI: 10.2500/ajra.2012.26.3707] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sinus fungus ball (SFB), previously termed mycetoma of the paranasal sinus is a type of noninvasive fungal rhinosinusitis and the treatment of choice for this condition is functional endoscopic sinus surgery. Predicting the possibility of SFB by performing preoperative computed tomography (CT) is important to ensure appropriate treatment. Various studies have reported the CT findings of SFB. We aimed to investigate the relationship between CT features and SFB to increase the preoperative diagnostic accuracy of CT. METHODS Based on a literature review, we selected six CT features of SFB including calcification, erosion of the inner wall of the sinus, sclerosis of sinus lateral wall, heterogeneous opacification of sinus, absence of an air-fluid level, and sinus mucosal thickening. From January 2004 to February 2010, 96 SFB patients and 72 unilateral chronic rhinosinusitis (CRS) patients were enrolled in this study. Preoperative CT images of all of the patients were interpreted by a radiologist and an otolaryngologist. RESULTS All of the CT features except mucosal thickening showed statistically significant differences between SFB and CRS group patients. After adjusting for these CT features in a multiple logistic regression model, only the two features, viz., calcification and erosion of the inner wall of the sinus, were found to have a significant positive association with SFB. CONCLUSION We found that five CT features, particularly calcification and erosion of the inner wall of the sinus, increase the diagnostic accuracy of CT for SFB, and this ensures that the patient receives appropriate treatment.
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Affiliation(s)
- Jia-Cheng Chen
- Department of Otolaryngology, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Pushker N, Meel R, Kashyap S, Bajaj MS, Sen S. Invasive Aspergillosis of Orbit in Immunocompetent Patients: Treatment and Outcome. Ophthalmology 2011; 118:1886-91. [DOI: 10.1016/j.ophtha.2011.01.059] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 01/26/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022] Open
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Imaging of granulomatous and chronic invasive fungal sinusitis: comparison with allergic fungal sinusitis. Otolaryngol Head Neck Surg 2010; 143:294-300. [PMID: 20647138 DOI: 10.1016/j.otohns.2010.02.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 01/24/2010] [Accepted: 02/19/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To study the radiological features of chronic/granulomatous invasive fungal sinusitis (IFS) and identify differentiating characteristics, if any, from allergic fungal sinusitis (AFS). STUDY DESIGN Prospective radiological study. SETTING Tertiary hospital in northern India. SUBJECTS AND METHODS Subjects were nonacute fungal sinusitis patients with orbital involvement presenting between January 1999 and December 2003. Seventeen IFS and 12 AFS patients with mean age 27 years (range 7-59 years) underwent computed tomographic scan (CT) and magnetic resonance imaging (MRI) of paranasal sinuses with contrast. These were operated within one month of doing the scans and had histologically confirmed fungal sinusitis. Outcome measures were characteristics of opacity produced by the diseased tissue on CT and MRI, side and number of sinuses involved, expansion of sinuses, areas of bone erosion, and extra-sinus extension. RESULTS IFS showed homogenous opacity (isodense or hyperdense to muscle tissue) on CT and isointense and hypointense signal on T1- and T2-weighted MR images respectively. IFS showed involvement of one or two sinuses only, homogenous contrast enhancement, lack of expansion of sinuses, and bone erosion localized to the area of extra-sinus extension, and the extra-sinus component of the disease was more than the intra-sinus component. AFS showed heterogenous opacities with hyperattenuation areas on CT, isointense/hypointense to signal void on T1- and T2-weighted MR images. Expansion of sinuses, extensive bone erosion, lack of contrast enhancement, multiple sinus involvement, and major bulk of disease being intra-sinus rather than extra-sinus were other characteristics of AFS. CONCLUSION Radiological features of IFS are described that are different from AFS.
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12
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Siddiqui AA, Bashir SH, Ali Shah A, Sajjad Z, Ahmed N, Jooma R, Enam SA. Diagnostic MR imaging features of craniocerebral Aspergillosis of sino-nasal origin in immunocompetent patients. Acta Neurochir (Wien) 2006; 148:155-66; discussion 166. [PMID: 16283103 DOI: 10.1007/s00701-005-0659-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 09/23/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Craniocerebral invasive Aspergillosis of sino-nasal origin has been reported with a very high mortality due to a peculiarly fulminant clinical course. Early diagnosis based on clinical radiological imaging may have an impact on final clinical outcome. This retrospective study focuses on characteristic MR imaging features of Aspergillosis (of sinonasal origin) in immunocompetent patients. METHODS Medical records of patients were reviewed retrospectively during the period from 1991 to 2003 in the two tertiary care hospitals. All the patients had radiological evidence of disease in the paranasal sinuses with or without intracranial extension. Immunocompetence of patients was assessed on clinical and radiological data. MRI scans (n=20) were reviewed by both clinical neurosurgeons and neuroradiologists separately. MRI was done on 1.5 tesla scanners and both T2-weighted and T1 weighted sequences were obtained followed gadolinium enhanced images. Patients were categorized into three types based on their anatomical location on MRI scans; type-1 being intracerebral, type-2 as intracranial extradural and type-3 invading orbit and/or skull base only. All these patient had the epicenter of disease in the nose and/or paranasal sinuses as evident on MR imaging. All patients underwent standard surgical intervention followed by antifungal therapy. Clinical outcome was assessed on Glasgow outcome scale with mean duration of clinical follow up of 13.9 months. FINDINGS Mean age of patents (n=20) was 31.1 years with male preponderance (3:1). MRI scans showed evidence of disease in paranasal sinuses including mucosal thickening (n=11) and complete filling of sinuses (n=9). T2-weighted images showed extremely hypo-intense fungal mass (n=19) while T1-weighted images had iso-intense signals (n=18). Gadolinium-enhanced images showed bright homogenous contrast enhancement (n=18) and peripheral ring enhancement pattern (n=2). All patients underwent appropriated surgical procedures depending upon anatomical location followed by standard antifungal therapy. Tissue diagnoses were established by histopathology (n=20) and culture growth (n=5). Overall mortality remained 15 percent. INTERPRETATION Craniocerebral Aspergillosis of sinonasal origin has typical MR imaging features. These features include a mass lesion producing hypo-to-iso-intense signals on T1-weighted, extremely low signals (hypo-intense) on T2-weighted images, with bright homogenous enhancement on post-gadolinium T1-weighted imaging. These features in the clinical background may be helpful in early diagnosis and management of Aspergillosis of sino-nasal origin in immunocompetent hosts. Prospective clinical study is required to make firm clinical therapeutic recommendations.
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Affiliation(s)
- A A Siddiqui
- Division of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan.
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El-Beltagi AH, Sobeih AA, Valvoda M, Dahniya MH, Badr SS. Radiological appearances of sinonasal abnormalities. Clin Radiol 2002; 57:702-18. [PMID: 12169281 DOI: 10.1053/crad.2001.0883] [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
The aim of this pictorial review is to present a variety of abnormalities of the sinonasal cavities to emphasize the diversity of lesions occurring in this region. These include congenital, neoplastic and granulomatous disorders and some allergic and inflammatory lesions with uncommon radiological appearances, as well as expanding lesions of the facial bones or of dental origin with secondary involvement of the related sinus(es).
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Affiliation(s)
- A H El-Beltagi
- Department of Diagnostic Radiology and Imaging, Kuwait, Kuwait
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14
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Drury AE, Allan RA, Underhill H, Ball S, Joseph AE. Calcification in invasive tracheal aspergillosis demonstrated on ultrasound: a new finding. Br J Radiol 2001; 74:955-8. [PMID: 11675315 DOI: 10.1259/bjr.74.886.740955] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Invasion of the major airways is a rare manifestation of respiratory tract involvement by Aspergillus sp. and is seen almost exclusively in immunocompromised patients. We present calcification as a new feature of this condition and its demonstration by ultrasound in a 15-year-old boy with severe neutropenia secondary to aplastic anaemia.
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Affiliation(s)
- A E Drury
- Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London SW17 0QT, UK
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Mirza N, Lanza DC. Diagnosis and management of rhinosinusitis before scheduled immunosuppression: a schematic approach to the prevention of acute fungal rhinosinusitis. Otolaryngol Clin North Am 2000; 33:313-21. [PMID: 10736406 DOI: 10.1016/s0030-6665(00)80007-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute (invasive) fungal rhinosinusitis is an aggressive and potentially lethal complication of insulin dependent diabetes, as well as immunosuppression from chemotherapy and bone marrow transplant. The goal of this article is to describe methods to help with the diagnosis and treatment of sinusitis prior to developing this state of immune-compromise. This will help eliminate a significant risk factor for these patients that can lead to serious morbidity and ultimately mortality.
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Affiliation(s)
- N Mirza
- Department of Microbiology, Duke University Medical Center, Durham, North Carolina, USA
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16
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Clark RA. Imaging in Bone Marrow Transplantation. Cancer Control 1999; 6:84-89. [PMID: 10758538 DOI: 10.1177/107327489900600109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- RA Clark
- Radiology Service, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
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17
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Mirza N, Montone KT, Stadtmauer EA, Lanza DC. A schematic approach to preexisting sinus disease for the immunocompromised individual. AMERICAN JOURNAL OF RHINOLOGY 1998; 12:93-8. [PMID: 9578926 DOI: 10.2500/105065898781390226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Fungal rhinosinusitis is an aggressive and potentially lethal complication of chemotherapy and bone marrow transplant-induced neutropenia. Preexisting noninvasive sinusitis may be a significant risk factor in this population. An illustrative case is presented where preexisting noninvasive fungal sinusitis developed into the tissue-invasive and angio-invasive form of aspergillosis during chemotherapy. We propose an algorithmic approach to all patients before chemotherapy or bone marrow transplantation. If there is a suspicion of sinusitis based on a screening questionnaire, we recommend an otolaryngology consultation and a CT of the paranasal sinuses. Evidence of sinus disease should then be treated aggressively before chemotherapy or a bone marrow transplantation. Close posttreatment surveillance during the neutropenic phase is necessary with "urgent" biopsies if recurrence of disease is suspected.
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Affiliation(s)
- N Mirza
- Department of Otolaryngology, Head and Neck Surgery, University of Pennsylvania Medical Center, Philadelphia 19104, USA
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18
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Dahniya MH, Makkar R, Grexa E, Cherian J, al-Marzouk N, Mattar M, Saghir E, Fathi al-Samman T. Appearances of paranasal fungal sinusitis on computed tomography. Br J Radiol 1998; 71:340-4. [PMID: 9616249 DOI: 10.1259/bjr.71.843.9616249] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The primary invasive granulomatous form of fungal sinusitis, due to inhalation of aspergillus spores, is commonest in the Sudan and the Gulf states. This condition often presents clinically as a chronic, severe sinusitis which has not responded to antibiotics. On CT scanning, the major feature is a soft tissue mass, which is either homogeneous or has lower attenuation components. There may be erosion or expansion of the bony margins of the sinuses. Intraorbital and/or intracranial extension sometimes occur.
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Affiliation(s)
- M H Dahniya
- Department of Diagnostic Radiology and Imaging, Al-Sabah Hospital, Kuwait
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19
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Manning SC, Merkel M, Kriesel K, Vuitch F, Marple B. Computed tomography and magnetic resonance diagnosis of allergic fungal sinusitis. Laryngoscope 1997; 107:170-6. [PMID: 9023239 DOI: 10.1097/00005537-199702000-00007] [Citation(s) in RCA: 144] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective of this study was to describe CT and MR findings in patients with allergic fungal sinusitis (AFS). CT and MR images were examined from 10 patients with histologically proven AFS. All patients demonstrated CT evidence of central sinus high attenuation and T2-weighted MR signal void corresponding to surgically proven areas of thick inspissated allergic mucin. AFS is a distinct clinical entity with a highly specific radiographic appearance based on CT and MRI.
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Affiliation(s)
- S C Manning
- Department of Otolaryngology, Children's Hospital and Medical Center, Seattle, Washington 98105-9035, USA
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20
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Levin LA, Avery R, Shore JW, Woog JJ, Baker AS. The spectrum of orbital aspergillosis: a clinicopathological review. Surv Ophthalmol 1996; 41:142-54. [PMID: 8890440 DOI: 10.1016/s0039-6257(96)80004-x] [Citation(s) in RCA: 127] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Orbital aspergillosis is an uncommon but serious infection that may first present to the ophthalmologist. Usually arising from the paranasal sinuses, it may present in manifold ways within the orbit. Some presentations, such as optic nerve involvement, can respond to systemic corticosteroids, leading to delays in diagnosis and possibly iatrogenic potentiation of the infectious process. In this review, pertinent clinical and radiographic findings are discussed, and the literature is summarized. Classic approaches to therapy include local treatment, debridement, and systemic amphotericin B. We review novel approaches to treating orbital aspergillosis and detail a flow-chart for its management. Four patients from the spectrum of orbital aspergillosis are also described: initially presenting as an infection of an exenteration socket, a complex dacryocystitis, and optic nerve tumor, and post-operative periorbital swelling. Physicians should be familiar with the clinical spectrum of disease and the variable presentation of this infection, as early diagnosis and rapid institution of appropriate therapy are crucial elements in the management of invasive aspergillosis. In the neutropenic or otherwise immunocompromised patient, a high index of suspicion must be maintained as delays in diagnosis of fulminant aspergillosis may lead to overwhelming and rapidly progressive infection. Obtaining adequate diagnostic material for pathological and microbiological examination is critical. Newer methods of therapy, particularly itraconazole and liposomal amphotericin B, may be beneficial in selected patients.
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Affiliation(s)
- L A Levin
- Department of Ophthalmology, University of Wisconsin Medical School, Madison, USA
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21
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Falworth MS, Herold J. Aspergillosis of the paranasal sinuses. A case report and radiographic review. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 81:255-60. [PMID: 8665325 DOI: 10.1016/s1079-2104(96)80426-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Aspergillosis of the paranasal sinuses is uncommon; however, its incidence in recent years has shown a marked increase, and it is believed that it may account for a number of cases of nonspecific sinusitis. It may present in one of four forms, one of which is the noninvasive Aspergillus mycetoma. One such case affecting the maxillary sinus is reported, and reference is made to its possible sequelae and management. The significance of its presentation as a radiodense focus within the antrum on plain radiographs and computed tomography is discussed, as is the use of magnetic resonance imaging for excluding aspergillosis from the differential diagnosis.
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Affiliation(s)
- M S Falworth
- Department of Oral and Maxillofacial Surgery, Royal Surrey County Hospital, UK
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22
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Lee LR, Sullivan TJ. Aspergillus sphenoid sinusitis-induced orbital apex syndrome in HIV infection. AUSTRALIAN AND NEW ZEALAND JOURNAL OF OPHTHALMOLOGY 1995; 23:327-31. [PMID: 11980081 DOI: 10.1111/j.1442-9071.1995.tb00185.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Orbital apex syndrome due to aspergillus sphenoid sinusitis is a rare condition. Human immunodeficiency virus (HIV) infection has recently been reported in aspergillus orbital abscess. To the authors' knowledge this is the first reported association of HIV with the orbital apex syndrome. METHODS A 37-year-old HIV-infected man presented with headache, reduced vision and progressive ophthalmoplegia in the right eye. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed sphenoid sinusitis. Sphenoid sinus biopsy was performed. RESULTS Light microscopy revealed infiltrative branching septate fungal hyphae. Fungal culture isolated Aspergillus fumigatus. CONCLUSION Atypical fungal infection such as Aspergillus fumigatus sphenoid sinusitis should be suspected in HIV-infected patients with orbital apex syndrome.
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Affiliation(s)
- L R Lee
- Department of Ophthalmology, Royal Brisbane Hospital, Herston Road, Herston 4029, Queensland
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23
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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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24
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Jamjoom AB, al-Hedaithy SA, Jamjoom ZA, al-Hedaithy M, el-Watidy SF, Rahman N, al-Moallem M. Intracranial mycotic infections in neurosurgical practice. Acta Neurochir (Wien) 1995; 137:78-84. [PMID: 8748874 DOI: 10.1007/bf02188786] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Intracranial mycotic infections requiring neurosurgical intervention are being diagnosed more frequently. This study is a review of 17 cases of intracranial mycotic infections that were treated in a neurosurgical unit in Saudi Arabia over an 8-year period. A primary focus of infection was identified in 41% of patients while 18% of patients had a predisposing factor. Forty-seven percent of patients presented with a brain abscess (solitary 29%, multiple 18%) while 35% had a granuloma. 18% meningitis and ventriculitis and 12% hydrocephalus. The Aspergillus species and Ramichloridium machenziei were the commonest pathogens. Following the appropriate surgical and antimicrobial treatment, the mortality rate was 41% and there was evidence of residual disease at follow-up in 18%. The reason for a fatal outcome was failure to consider a fungal aetiology and to obtain a tissue diagnosis early-because of late referral (2 cases), as well as failure to respond to antimycotic therapy (4 cases) and rupture of the internal carotid artery due to Aspergillus arteritis (one case). It is concluded that an early tissue diagnosis is crucial in the management of intracranial mycotic infection so that the appropriate surgical and antimycotic treatment can be started early.
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Affiliation(s)
- A B Jamjoom
- Division of Neurosurgery, King Khalid University Hospital, Riyadh, Saudi Arabia
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25
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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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