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24 year old male with right proptosis for 3 months.

Spectrum of mycotic infections

Benign, extra-mucosal

Invasive, fulminant form

CT

Hyperdense fungal material

May contain central calcifications

MR

Low-to-intermediate signal on T1 due to diminished water/protein content

Low signal on T2

Dark T1 and T2 signal may mimic air!

Chronic, noninvasive form

Sinonasal cavity colonized with fungus

Usually affects a single sinus

Maxillary > sphenoid

Typically Aspergillus

Clinical

Immunocompetent

Non-atopic

Minimally symptomatic

Excellent response to surgical resection.

Severe form of chronic rhinosinusitis

Eosinophilic mucin containing noninvasive hyphae (Aspergillus, Bipolaris, Fusarium)

Multiple sinus opacification and expansion

Hyperdense material on CT surrounded by hypodense mucosa

Remodeling and thinning of sinus walls

May result in bony erosion

May extend into orbits and/or cranial cavity

Clinical

Slow, indolent course

Immunocompetent, atopic

Often associated with sinonasal polyposis

Facial deformity

Local excision, steroid therapy.

Rapidly progressive fungal infection

Aspergillus

Mucormycosis

Diabetic and immunocompromised patients

Complete or partial opacification of sinus with areas of bony erosion and adjacent soft tissue infiltration

Maxillary > ethmoid > sphenoid.

Arterial invasion

Hyphae grow along internal elastic lamina and may extend into lumen

Dissection, narrowing or occlusion

Orbital and intracranial extension

Poor prognosis

Cavernous sinus thrombosis, carotid occlusion, mycotic aneurysm, cerebral infarction

May be fatal unless appropriate surgical-medical management

Radical debridement, antifungal therapy.