To demonstrate the differences in CT and MRI findings in acute invasive fungal sinusitis and how MRI is the superior modality in evaluating extra-sinus disease.

Acute invasive fungal rhinosinusitis (AIFR) is a rare but often fatal condition with mortality rates between 50-80%.1 It is a disease which typically afflicts immunocompromised patients, commonly those with diabetes mellitus (DM) or haematologic malignancies.1 Common pathogens include Aspergillus spp. as well as fungi belonging to the order Zygomycetes, which comprises Rhizopus, Rhizomucor, Mucor and Absidia.2 Two cases at a tertiary hospital in Melbourne emphasise that CT findings in AIFR poorly reflect the severity of disease and that MRI is better at evaluating extra-sinus spread...

Case I A 48-year-old female with relapsed acute myeloid leukaemia presented with one month of fevers and 10 days of facial pain and rhinorrhoea. Clinical examination of the nose showed patchy necrotic sinonasal mucosa bilaterally. Non-contrast computed tomography (CT) of the sinuses demonstrated diffuse pansinus mucosal thickening with surrounding hyperostosis; findings in keeping with chronic sinusitis. Additionally, there was hyperdense material within the right maxillary sinus, suggestive of a fungal aetiology. There was no osseous erosion or extra-sinus extension. (Figure 1) Given the clinical concern...

These cases summarise key findings on CT and MRI in AIFR, but also highlight that MRI is the superior modality when evaluating severity and extent of extra-sinus spread of disease.

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