Fact-sheet: Sinus Aspergillosis
- Sinus aspergilloma
Updated on 07/18/2019 at 11:15 AM
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Definition
Noninvasive sinus mycoses are chronic fungal sinusitis, nonaggressive, extramucosal, occurring most often in immunocompetent patients, presenting as mycetomas (aspergillomas).
Most frequent maxillary location, generally unilateral.
Noninvasive aspergillosis includes sinus aspergilloma and allergic fungal sinusitis.
The invasive nature is based essentially on the presence of bone lysis and extension into the surrounding soft tissues.
Contamination and predisposing factors:
Respiratory contamination ++
Intrasinus passage of dental paste (contains certain heavy ions such as zinc oxide, favoring the growth of Aspergillus)
Clinical features
Chronic sinusitis or rhinosinusitis refractory to medical treatment:
Nasal obstruction with or without anosmia
Purulent discharge of compact mucopurulent casts or crusts
Facial pain
Laboratory findings
Aspergillus fumigatus in 80% of cases
Radiography
Increased density of the maxillary sinuses
Circumferential thickening of the sinus mucosa
Foreign body or intrasinus calcification
CT
- The presence of calcifications within a focus of chronic sinusitis on CT is highly suggestive of aspergillary infection
- Spontaneously hyperdense filling of the nasosinal cavities is highly suggestive of fungal origin.
- Mucosal thickening and/or intrasinus opacification and osteosclerosis of the bony walls indicating chronicity
- +/- pansinus opacification, possible intraorbital/intracranial extension
invasive features: bone lysis, extension into facial soft tissues, intraorbital extension
MRI
- Hypointense sinus opacification on T2
- Intrasinus hypointensity on T1, sometimes very heterogeneous
- After injection: enhancement of the inflammatory mucosa
- If intracranial extension, invasive features: meningeal enhancement after injection
Management
Treatment primarily surgical: sinus drainage surgery
Prolonged follow-up by CT