Case 40 - Fungus Ball

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

CT Head WITH AND without contrast:

CLINICAL HISTORY: Concern for nocardia or other lung associated infection

COMPARISON: None.

PROCEDURE COMMENTS: CT of the head was performed with and without IV contrast. 120 cc of Omnipaque intravenous contrast was administered without complication.

FINDINGS:

Parenchyma: Normal unenhanced appearance of the brain parenchyma. No abnormal mass or enhancement. No evidence of abscess. Gray-white differentiation is preserved. No evidence of intracranial hemorrhage or territorial infarct.

Ventricles and extra-axial spaces: Appropriate for age. No extra axial collection. Basal cisterns are clear.

Visualized paranasal sinuses: There is near-complete opacification of the left maxillary sinus with intrinsically hyperdense central serpiginous foci. There is peripheral enhancement of the mucosa but is without central enhancement. There is circumferential bony thickening without evidence of erosions, suggestive of chronic sinusitis. Retroantral fat is preserved. Symmetric appearance of the cavernous sinuses and orbital apices.

Remaining paranasal sinuses and nasal cavity are clear.

Mastoid air cells: Clear.

Bones: Diffuse thickening of the left maxillary sinus as above. Otherwise unremarkable with no suspicious osseous lesion.

Other: Major intracranial arteries and dural venous sinuses are grossly patent.

IMPRESSION:

1. No acute intracranial abnormality. No intracranial mass, abscess, or other abnormal intracranial enhancement.

2. Findings as detailed above are most compatible with allergic fungal sinusitis. Associated circumferential bony thickening without evidence of erosions is suggestive of chronic process. Remaining paranasal sinuses and nasal cavity are clear.