Case 43 - Allergic Fungal Sinusitis with Mucocele
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I want to show a quick example of allergic fungal sinusitis
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and one of its complications. With allergic fungal sinusitis,
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as I mentioned,
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you tend to see the infection in bilateral and multiple sinuses.
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So in this case, we see that there is hyperdense
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secretions in the right maxillary antrum.
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We see that there is expansion of the maxillary sinus ostium
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by the fungal polyps that are involving the
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maxillary antrum and the ostiomeatal unit.
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You notice also that there is hyperdense secretions in the
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ethmoid sinus, and these hyperdense secretions of the
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ethmoid sinus are obstructing the frontal ethmoidal recess or
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what some people refer to as the
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nasofrontal or frontal nasal duct.
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Now, this patient shows marked expansion of
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the frontal sinus with thinning of the bone.
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This is not an acute process,
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this is a long standing process secondary to the obstruction
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of the outflow from the right frontal sinus, leading to
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expansion of that sinus in what we call a mucocele.
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Now, the etiology of the mucocele is the fungal
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polyps and the allergic fungal sinusitis,
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but the process that is indenting the brain tissue
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and sometimes even causing hypoglobus.
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By hypoglobus, we mean that the globe is pushed downward and
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this expansion of the frontal sinus may displace
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the globe downward, as you can see here,
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with the periosteum being displaced downward, leading to
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the globe on the right side, being lower in
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position than the globe on the left side.
David M Yousem, MD, MBA
Professor of Radiology, Vice Chairman and Associate Dean
Johns Hopkins University
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