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Case 40 - Fungus Ball

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Hyperdensity within the perinasal sciences may

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be on the basis of several different etiologies.

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Certainly in the trauma setting, we're more

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likely to suggest that the hyperdensity,

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particularly if it's in their fluid level,

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represents blood products in the sinus.

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Sometimes we have hyperdensity in the sinus merely

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on the basis of hyperproteinesis secretions which,

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because of the absence of water, becomes more dense.

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The third scenario where we see hyperdense secretions is in a

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patient who has a fungus ball, and the fourth scenario is when

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you have polyps. But the polyps may

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also be on an allergic fungal basis.

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In this case we have true calcification seen

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within the left maxillary antrum.

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We're encouraged by the presence of bony thickening, suggesting

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this is a chronic process rather than acute invasive process.

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And we also see that there is a peripheral rim of enhancement

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around these secretions. Again, suggesting a chronic process.

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This turned out to be a fungus ball and the fungus ball is one

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of the hyperdense lesions in the paranasal

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sinuses, which can calcify.

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Occasionally, you'll see that the fungus ball protrudes

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into the nasal cavity from the maxillary antrum.

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But when you have a more diffuse process, which is bilateral

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hyperdense extending into the sinuses, as well as in the nasal

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cavity, we're going to suggest allergic fungal sinusitis.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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