Fungal Spectrum in Sinus Disease. Radiological Findings on CT and MR with histological correlation

Congress:

ECR 2019

Poster Number:

C-1023

Type:

Educational Exhibit

Keywords:

Infection, Acute, Education, MR, CT, Head and neck, Inflammation

Authors:

C. A. Robles¹, A. Torres¹, G. A. Miranda², P. Orellana¹, K. Bezares¹, R. Núñez Flores¹, M. López Ramírez¹, J. de Grazia², A. Salas¹; ¹Santiago/CL, ²Santiago, RM/CL

DOI:

10.26044/ecr2019/C-1023

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-1023

Fig. 1: Flowchart of Sinus Disease.

Fig. 2: 53 y/o woman. CT (a) (c) soft tissue window and bone window (b) (d). Nodular...

Fig. 3: MRI, same patient. (a) T2 WI, (b) T1 WI, (c) Coronal T1 WI fat sat and (d) T1...

Fig. 4: 52 y/o male. CT (a) (b) Soft tissue window setting and (c) (d) Bone window...

Learning objectives

To discuss the radiological findings of the different fungal diseases in sinuses with representative cases on CT and MR.

Background

Fungal sinusitis corresponds to a wide spectrum of diseases which depends on 2 important factors. The first is a normal immune state of the host, that prevent the infection and dissemination of the disease. The second is the virulence of the fungi that is implicated, because only few fungi are truly pathogens to the humans. The more common fungi that causes disease in humans areAspergillus, BipolarisandRhizopus. The interaction between fungi and host ranges from a simple colonization to fatal infection. Has to be noted that...

Findings and procedure details

Fungus ball, Allergic fungal sinusitis, acute invasive, chronic invasive and chronic granulomatous invasive sinusitis are 5 subtypes of fungal spectrum disease in sinuses that will be discuss shortly on this review. Non Invasive Sinusitis a. Fungus Ball: Uncommon variant of fungal sinus disease also known as Mycetoma, which is mainly seen in immunocompetent elderly patients. Is more prevalent in females. It’s thought to be caused by inefficient mucociliary clearance. The fungi proliferate and incite an inflammatory response.Usually there is only one sinus compromised. Imaging Findings:...

Conclusion

Fungal sinusitis are a wide spectrum disease. Clinical and imaging findings could help in address a prompt diagnosis. The immune status of the patient helps to narrow the diagnosis. Sinus expansion and bone reaction are ancillary findings that should be analysed when a fungal sinusitis is suspected.

Personal information

References

Manohar Aribandi, Victor A. McCoy, Carlos Bazan. Imaging Features of Invasive and Noninvasive Fungal Sinusitis: A Review. RadioGraphics 2007; 27:1283–1296 E.H. Middlebrooks, C.J. Frost, R.O. De Jesus, T.C. Massini, I.M. Schmalfuss and A.A. Mancuso. Acute Invasive Fungal Rhinosinusitis: A Comprehensive Update of CT Findings and Design of an Effective Diagnostic Imaging Model. AJNR Am J Neuroradiol 36:1529 –35. Aug 2015 Gavito-Higuera J, Mullins CB, Ramos-Duran L, Sandoval H, Akle N, Figueroa R. Sinonasal Fungal Infections and Complications: A Pictorial Review. Journal of Clinical Imaging Science....