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0:01

Hyperdensity within the perinasal sciences may

0:04

be on the basis of several different etiologies.

0:09

Certainly in the trauma setting, we're more

0:11

likely to suggest that the hyperdensity,

0:14

particularly if it's in their fluid level,

0:15

represents blood products in the sinus.

0:18

Sometimes we have hyperdensity in the sinus merely

0:20

on the basis of hyperproteinesis secretions which,

0:25

because of the absence of water, becomes more dense.

0:29

The third scenario where we see hyperdense secretions is in a

0:33

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

0:36

you have polyps. But the polyps may

0:40

also be on an allergic fungal basis.

0:43

In this case we have true calcification seen

0:46

within the left maxillary antrum.

0:49

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

0:53

this is a chronic process rather than acute invasive process.

0:57

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

1:01

around these secretions. Again, suggesting a chronic process.

1:05

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

1:09

of the hyperdense lesions in the paranasal

1:12

sinuses, which can calcify.

1:15

Occasionally, you'll see that the fungus ball protrudes

1:17

into the nasal cavity from the maxillary antrum.

1:20

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

1:25

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

1:30

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

Case: Fungus Ball

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0:01

Hyperdensity within the perinasal sciences may

0:04

be on the basis of several different etiologies.

0:09

Certainly in the trauma setting, we're more

0:11

likely to suggest that the hyperdensity,

0:14

particularly if it's in their fluid level,

0:15

represents blood products in the sinus.

0:18

Sometimes we have hyperdensity in the sinus merely

0:20

on the basis of hyperproteinesis secretions which,

0:25

because of the absence of water, becomes more dense.

0:29

The third scenario where we see hyperdense secretions is in a

0:33

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

0:36

you have polyps. But the polyps may

0:40

also be on an allergic fungal basis.

0:43

In this case we have true calcification seen

0:46

within the left maxillary antrum.

0:49

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

0:53

this is a chronic process rather than acute invasive process.

0:57

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

1:01

around these secretions. Again, suggesting a chronic process.

1:05

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

1:09

of the hyperdense lesions in the paranasal

1:12

sinuses, which can calcify.

1:15

Occasionally, you'll see that the fungus ball protrudes

1:17

into the nasal cavity from the maxillary antrum.

1:20

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

1:25

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

1:30

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

Paranasal sinuses

Neuroradiology

Infectious

Head and Neck

Emergency

CT

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