Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2021, Vol. 35 ›› Issue (5): 32-35.doi: 10.6040/j.issn.1673-3770.0.2021.041

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Computed tomography-based preoperative diagnosis of fungal ball sinusitis

QIN He1, WAN Baogang2, WANG Hongli1, ZHAO Benqi3   

  1. 1. Department of Otorhinolaryngology & Head and Neck Surgery, Beijing Tsinghua Changgung Hospital/School of Clinical Medical, Tsinghua University, Beijing 102218, China;
    2. Health Care Department of the Outpatient Department, The Air Force Command of the Chinese People's Liberation Army, Beijing 100843, China;
    3. Department of Radiology, Beijing Tsinghua Changgung Hospital/School of Clinical Medical, Tsinghua University, Beijing 102218, China
  • Published:2021-09-29

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Abstract: Objective To investigate the computed tomography(CT)features of fungal ball sinusitis and evaluate their preoperative usefulness in differential diagnosis. Methods The CT scans of 32 patients preoperatively diagnosed with fungal ball sinusitis between January 2019 and December 2020 were retrospectively analyzed. The perioperative findings were compared with the preoperative CT findings. Histopathology and fungal smears were performed postoperatively. Results Of the 32 patients, 30 were diagnosed with fungal ball sinusitis based on the perioperative findings and postoperative histopathology; the diagnostic accuracy was 93.7%. In these 30 patients, the CT characteristics included intralesional hyperdensity, calcification spots, irregular surfaces, and sclerosis of the lateral sinus wall. Among the two other patients, one was diagnosed with eosinophilic papilloma of the maxillary sinus and the other was pathologically diagnosed with hemorrhagic necrotizing polyps. Conclusion Intralesional hyperdensity with calcification spots is a specific CT feature of fungal ball sinusitis. Partial opacification with an irregular surface and bony sclerosis in the areas affected by sinusitis are also CT characteristics. There is a risk of misdiagnosis when diagnosis is based solely on CT examinations.

Key words: Fungi ball, Nasal sinusitis, Tomography, X-ray computed, Endoscopic sinus surgery

CLC Number: 

  • R765.4
[1] Ilica AT, Mossa-Basha M, Maluf F, et al. Clinical and radiologic features of fungal diseases of the paranasal sinuses[J]. J Comput Assist Tomogr, 2012, 36(5): 570-576. doi:10.1097/RCT.0b013e318263148c.
[2] Tomazic PV, Dostal E, Magyar M, et al. Potential correlations of dentogenic factors to the development of clinically verified fungus balls:aretrospective computed tomography-based analysis[J]. Laryngoscope, 2016, 126(1): 39-43. doi:10.1002/lary.25416.
[3] Kim JS, So SS, Kwon SH. The increasing incidence of paranasal sinus fungus ball: a retrospective cohort study in two hundred forty-five patients for fifteen years[J]. Clin Otolaryngol, 2017, 42(1): 175-179. doi:10.1111/coa.12588.
[4] Lim HS, Yoon YH, Xu J, et al. Isolated sphenoid sinus fungus ball: a retrospective study conducted at a tertiary care referral center in Korea[J]. Eur Arch Otorhinolaryngol, 2017, 274(6): 2453-2459. doi:10.1007/s00405-017-4468-0.
[5] Huang ZX, Xu HF, Xiao NC, et al. Predictive significance of radiographic density of sinus opacity and bone thickness in unilateral maxillary sinus Mycetoma[J]. ORL J Otorhinolaryngol Relat Spec, 2019, 81(2/3): 111-120. doi:10.1159/000496829.
[6] Ho CF, Lee TJ, Wu PW, et al. Diagnosis of a maxillary sinus fungus ball without intralesional hyperdensity on computed tomography[J]. Laryngoscope, 2019, 129(5): 1041-1045. doi:10.1002/lary.27670.
[7] Nomura K, Asaka D, Nakayama T, et al. Sinus fungus ball in the Japanese population: clinical and imaging characteristics of 104 cases[J]. Int J Otolaryngol, 2013, 2013: 731640. doi:10.1155/2013/731640.
[8] 郑炯,李璟. 真菌性鼻-鼻窦炎的CT影像特征[J].山东大学耳鼻喉眼学报,2014,28(5): 45-48. doi:10.6040 /j.issn.1673-3770.0.2014.042. ZHENG Jiong, LI Jing. Characteristics of computed tomography of fungal [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2014, 28(5): 45-48. doi:10.6040 /j.issn.1673-3770.0.2014.042.
[9] Kim JS, Kim BK, Hong SD, et al. Clinical characteristics of sphenoid sinus fungal ball patients with visual disturbance[J]. Clin Exp Otorhinolaryngol, 2016, 9(4): 326-331. doi:10.21053/ceo.2015.01571.
[10] Lop-Gros J, Gras-Cabrerizo JR, Bothe-González C, et al. Fungus ball of the paranasal sinuses: Analysis of our serie of patients[J]. Acta Otorrinolaringol Esp, 2016, 67(4): 220-225. doi:10.1016/j.otorri.2015.09.005.
[11] Lee DH, Yoon TM, Lee JK, et al Computed tomography-based differential diagnosis of fungus balls in the maxillary sinus[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2020,129: 277-281. doi: 10.1016/j.oooo.2019.08.008.
[12] Jiang ZD, Zhang K, Huang WX, et al. A preliminary study on sinus fungus ball with MicroCT and X-ray fluorescence technique[J]. PLoS One, 2016, 11(3): e0148515. doi:10.1371/journal.pone.0148515.
[13] 孙勇, 张凤久, 冯勃. 真菌球型鼻窦炎的病变部位分布及CT影像特征分析[J]. 解放军医学院学报, 2017, 38(5): 456-458. doi: 10.3969/j.issn.2095-5227.2017.05.019. SUN Yong, ZHANG FJ, FENG Bo. Fungus ball sinusitis: distribution and CT imaging characteristics[J]. Acad J Chin PLA Med Sch, 2017, 38(5): 456-458. doi: 10.3969/j.issn.2095-5227.2017.05.019.
[14] Lee JH, Lee BD. Characteristic features of fungus ball in the maxillary sinus and the location of intralesional calcifications on computed tomographic images: a report of 2 cases[J]. Imaging Sci Dent, 2020, 50(4): 377-384. doi:10.5624/isd.2020.50.4.377.
[15] Cha H, Song Y, Bae YJ, et al. Clinical characteristics other than intralesional hyperdensity may increase the preoperative diagnostic accuracy of maxillary sinus fungal ball[J]. Clin Exp Otorhinolaryngol, 2020, 13(2): 157-163. doi:10.21053/ceo.2019.00836.
[16] Yoon YH, Xu J, Park SK, et al. A retrospective analysis of 538 sinonasal fungus ball cases treated at a single tertiary medical center in Korea(1996-2015)[J]. Int Forum Allergy Rhinol, 2017, 7(11): 1070-1075. doi:10.1002/alr.22007.
[17] Robey AB, O'Brien EK, Richardson BE, et al. The changing face of paranasal sinus fungus balls[J]. Ann Otol Rhinol Laryngol, 2009, 118(7): 500-505. doi:10.1177/000348940911800708.
[18] Jun YJ, Shin JM, Lee JY, et al. Bony changes in a unilateral maxillary sinus fungal ball[J]. J Craniofac Surg, 2018, 29(1): e44-e47. doi:10.1097/SCS.0000000000004010.
[19] Ni Mhurchu E, Ospina J, Janjua AS, et al. Fungal rhinosinusitis: a radiological review with intraoperative correlation[J]. J L'association Can Des Radiol, 2017, 68(2): 178-186. doi:10.1016/j.carj.2016.12.009.
[20] 秦贺.上颌窦嗜酸细胞乳头状瘤一例并文献复习[J].肿瘤研究与临床,2019, 31(5):845-846. doi: 10.3760/cma.j.issn.1006-9801.2019.12.012. QIN He. Oncocytic schneiderian papolloma in maxillary sinus: report of one case and review of liberature[J].Cancer Reasearch and Clinic,2019,31(12):845-846. doi: 10.3760/cma.j.issn.1006-9801.2019.12.012.
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