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Case No. 094
0000-00-00~0000-00-00
출제자 : 관리자
Hit : 426
| Period | 0000-00-00~0000-00-00 |
|---|---|
| Diagnosis | |
| Clinical information | 52세 여자, 일년 간의 두통, 콧물, 코막힘으로 내원 |
| Discussion | Fungal Sinusitis Imaging findings > On PNS CT, nonenhanced soft tissue density lesion filling left sphenoid sinus. Centrally located calcification among the soft tissue density in left sphenoid sinus. Expansile growth pattern of the soft tissue lesion with bony remodeling of contiguous left ethmoid sinus. Radiologic diagnosis > R/O Fungal sinusitis, most likely R/O Mucocele, less likely Clinical diagnosis > Fungal sinusitis. Operation findings and pathologic report > FESS : Polypoid mucosa in left spheno-ethmoidal recess. Fungal debri in left sphenoid sinus. Pathologic report : Aspergillosis Discussion > Fungal sinusitis >> Pathogen : aspergillosis, mucormycosis, candidiasis, histoplasmosis, cryptococcosis, coccidioidomycosis, North American blastomycosis, rhinosporidiosis, and myospherulosis. >> Clinicopathologic classifications. 1. Invasive - mucosal invasion. (1) Acute invasive fulminant disease : immunocompromised patients. (2) Chronic invasive infection : immunocompromised patient, DM (3) Chronic granulomatous disease : Immunocompetent patient. 2. Noninvasive (1) Noninvasive mycotic colonization (“fungus ball” or mycetoma) (2) Allergic mycotic sinusitis : History of asthma or atopy, nasal polyp. >> Imaging finding : Intrasinus calcification (51%), bony destruction of sinus wall on CT # Chronic sinusitis of nonfungal sinusitis vs fungal sinusitis. : calcification - central location, popcorn-like pattern in fungal sinusitis. peripheral location, smooth-margin round or eggshell app. in nonfungal. # (1) Acute invasive fulminant disease : single sinus (2) Chronic invasive infection (3) Chronic granulomatous disease (4) Noninvasive mycotic colonization ("fungus ball" or mycetoma) : single sinus, enhanced mass within the soft tissue density in involved sinus. Calcification. (5) Allergic mycotic sinusitis : multiple sinus involvement. |
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