Rc. Howells et Hh. Ramadan, Usefulness of computed tomography and magnetic resonance in fulminant invasive fungal rhinosinusitis, AM J RHINOL, 15(4), 2001, pp. 255-261
Fulminant invasive fungal rhinosinusitis is an aggressive, destructive proc
ess most commonly affecting the immunocompromised host. Although frequently
fatal, prognosis is related directly to early recognition and aggressive t
reatment. Various reports advocate computed tomography (CT) scanning as the
study of choice in evaluating suspected invasive fungal disease, reserving
magnetic resonance imaging (MRI) for select cases. Others report lack of c
orrelation between CT and surgical or pathological findings. Our aim was to
investigate the usefulness of CT and AIR in the diagnosis of invasive fung
al rhinosinusitis. We retrospectively reviewed four cases of biopsy-proven
invasive disease. Correlations between radiographic, endoscopic, and surgic
al findings were investigated. Rhizopus species were detected in three case
s and mixed Mucor and Aspergillus species in another. Superimposed bacteria
l sinusitis was confirmed in all cases. CT findings were nonspecific, revea
ling pansinusitis; no bone destruction or intracranial extension was noted.
Mild orbital cellulitis was noted in one case. Anterior rhinoscopy reveale
d nonviable tissue in two patients. Nasal endoscopy later confirmed tissue
ischemia in a third patient, whereas a final patient had normal findings on
both examus. Nonspecific findings resulted in delay of diagnosis by 48-72
hours in two patients with presumed bacterial sinusitis. MR revealed intrac
ranial extension in two patients and better represented intraoperative find
ings. In conclusion, CT findings in invasive fungal rhinosinusitis may be n
onspecific and underestimate extent of disease. A high index of suspicion a
nd early endoscopic examination with biopsy are mandatory for evaluation. M
RI may better represent disease progression and should be considered early.