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Age: 75

Sex: Male

Indication: Neutropenic fever

Save ("V")

Case #17


Findings

  • Circumferential mucosal thickening of the right maxillary sinus with bony dehiscence in the anterior and posterior walls and orbital floor
  • Soft tissue extension superiorly into the right orbital floor contacting the inferior rectus muscle as well as posteriorly into the retroantral fat and pterygopalatine fossa
  • Mild ethmoid, right sphenoid, and right frontal sinus mucosal thickening


Diagnosis

  • Invasive fungal sinusitis

Sample Report

Circumferential mucosal thickening of the right maxillary sinus with multifocal bony destruction and soft tissue extension superiorly into the right orbit contacting the inferior rectus muscle and posteriorly into the retroantral fat and pterygopalatine fossa. Findings are concerning for invasive fungal sinusitis in this neutropenic patient. Contrast enhanced face/sinuses MRI could further evaluate extent of disease, including evaluation for early intracranial extension.


Discussion

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Images

Red arrow: invasive disease through the posterior wall of the maxillary sinus into the retroantral fat. Green arrow: normal retroantral fat plane on the left for comparison. Red arrow: invasive disease through the orbital floor contacting the inferior rectus muscle, which is thickened. Green arrow: normal left inferior rectus muscle for comparison. Red arrow: abnormal soft tissue density in the pterygopalatine fossa representing invasive fungal sinusitis. Green arrow: normal fat in the left pterygopalatine fossa.



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