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| TEACHING IMAGES |
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| Year : 2015 | Volume
: 3
| Issue : 1 | Page : 157-158 |
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Sinus fungal ball
KS Gangadhara Somayaji1, Rajeshwary Aroor2, A Mohammad Nalapad1, Shreepad Shetty1
1 Department of ENT, Yenepoya Medical College, Nithyananda Nagara, Deralakatte, Mangalore, Karnataka, India
2 Department of ENT, K S Hegde Medical Academy, Mangalore, Karnataka, India
| Date of Web Publication | 13-Apr-2015 |
Correspondence Address:
Prof. Dr. K S Gangadhara Somayaji
Department of ENT, Yenepoya Medical College, Mangalore - 575 018, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2321-4848.154971
How to cite this article:
Gangadhara Somayaji K S, Aroor R, Nalapad A M, Shetty S. Sinus fungal ball
. Arch Med Health Sci 2015;3:157-8 |
| Case Report | |  |
A 45-year-old non-diabetic male patient presented to ENT clinic with history of right-sided nasal obstruction, mucopurulent nasal discharge, and right-sided facial pain of 3 months duration not responding to antibiotic treatment. Nasal endoscopy revealed purulent nasal discharge in the right middle meatus and nasal cavity. Rest of ENT examination was normal. CT scan showed heterogenous opacity with calcification and widening of maxillary sinus ostium and partial destruction of medial wall of maxillary sinus suggestive of granulomatous disease or malignancy [Figure 1]. Patient underwent FESS under GA. Right maxillary sinus was filled with brownish-white cheesy material extending onto the middle meatus and right nasal cavity [Figure 2]. Histopathological examination was suggestive of Aspergillosis. Patient recovered completely after the procedure. | Figure 1: Showing the CT image of the PNS with opacity and hyper attenuation in the right nasal cavity and maxillary sinus
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| Discussion | | |
A fungus ball is the sequestration of fungal hyphal elements within a sinus without invasive or granulomatous changes. The disease begins with the inhalation of spores that then become sequestered in a specific location, usually the maxillary sinus (69-86% of cases). Growth of the fungus then occurs while evading the host immune system. [1] In most cases, the offending agent is Aspergillus flavus or fumigatus. Occasionally, other fungi such as Pseudallescheria boydii and Alternaria have been implicated. [1] Clinical symptoms are secondary to mass effect and sinus obstruction. Many of them present with features of rhinosinusitis. [2] Diagnosis is by imaging and biopsy. A fungus ball typically appears hyperattenuating at non-contrast CT due to dense matted fungal hyphae and may demonstrate punctuate calcifications. The inflamed mucosal lining of the paranasal sinus is frequently hypoattenuating at non-contrast CT and hyperintense on T2-weighted images with contrast enhancement. [2] Radiodensities suggestive of calcifications may be diagnostic of fungal ball. [3] 3-17% of the cases may show bone destruction. [1] The treatment of choice for a sinus fungal ball is complete surgical removal of the disease by endoscopic approach. In addition, sinonasal irrigations help in washing out the debris. Antifungal therapy is usually not required unless there is recurrence of disease or the patient is at high risk for invasive disease. [1] However, Fergusson has recommended the use of itraconazole in immunocompromised patients. [3]
| References | | |
| 1. | Gleinser D, Maeso P, Quinn FB, and Quinn MS. Fungal sinusitis. Grand round presentation. UTMB health, Department of ORL. January 2012.  |
| 2. | Aribandi M, Mecoy VA, Bazan C. Imaging features of invasive and non invasive fungal sinusitis. A review. Radiographics 2007;27:1283-96. |
| 3. | Ferguson BJ. Fungal balls of PNS. Otolaryngol Clin North Am 2000;33:389-98. |
[Figure 1], [Figure 2]
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