Case #38

Case #36

Sample Report

Findings highly concerning for invasive fungal sinusitis with sinus disease involving the left sphenoid sinus, left greater than right maxillary sinuses, and bilateral ethmoid air cells and contiguous extension with left preseptal and postseptal orbital cellulitis, cellulitis/myositis involving the left masticator and parapharyngeal spaces, and evidence of intracranial extension with left superior ophthalmic vein and left cavernous sinus thrombosis. No peripherally enhancing collection to suggest abscess. No convincing enhancement of the left ophthalmic artery is concerning for thrombosis, which could be further evaluated with CTA or catheter angiography. Recommend urgent surgical consultation.

Restricted diffusion involving the orbital and canalicular segments of the left optic nerve concerning for infectious involvement and/or infarct.

Findings consistent with perineural spread of infection along the V3 branch of the left trigeminal nerve from the left masticator space, through foramen ovale, and involving the left Meckel’s cave with further retrograde extension along the cisternal segment of the left trigeminal nerve into the left dorsolateral pons.

Hypoenhancement of the left middle and inferior nasal turbinates concerning for necrosis.