Invasive fungal sinusitis clinical and imaging details

Invasive fungal sinusitis

1. Clinical Combined Rounds Department of Radio-diagnosis Dr. Pankaj Kumar Meena Senior Resident Department of Radiodiagnosis Dr.(Prof.) Shibani Mehra Consultant & Head of department Department of Radiodiagnosis

2. Clinical History 37-year-old female, post-renal transplant , on immmunosuppresant Presented with right-sided nasal obstruction, facial swelling & orbital symptoms Clinical suspicion: Invasive fungal sinusitis ( Mucormycosis )

3. CE-MRI PNS Findings Mucosal thickening & enhancement in right maxillary & ethmoid sinuses T2 hyperintense content with diffusion restriction Non-enhancing low-signal fungal hyphae/necrotic material Pre-antral & post-antral soft tissue involvement Mild enhancing soft tissue in floor of right orbit; inferior rectus normal No cavernous sinus, PPF, or intracranial extension

4. CECT PNS Findings Heterogeneously enhancing soft tissue density : - Right maxillary & anterior ethmoid sinus - Central hyperdense areas (65 HU) → likely fungal elements Posterolateral wall erosion with postantral fat obliteration → post -antral extension Extension into inferior orbital fat pad via infra-orbital foramen Inferior rectus muscle spared Left-sided sinuses and frontal recess normal

5. Correlation: CT vs MRI CT → Better for bony erosion, sinus opacification, HU measurement MRI → Better for fungal characterization, soft tissue extension, orbital ,PPF, cavernous sinus & intracranial involvement Both modalities complement each other in invasive fungal sinusitis diagnosis

6. Final Impression Features suggestive of Invasive fungal sinusitis - Right maxillary & anterior ethmoid sinus involvement - Maxillary sinus posterolateral wall erosion with retroantral fat extension - O rbital fat extension via infraorbital foramen - MRI confirms fungal hyphae & post-antral soft tissue spread

7. Teaching Points High suspicion in immunocompromised & post-transplant patients CT → Bony erosions, sinus involvement MRI → Fungal elements, soft tissue, orbital & intracranial extension Early diagnosis improves prognosis Multimodality approach is essential