Purpose: It is important to differentiate fungal from nonfungal sinusitis for optimal treatment and to prevent complications in immunocompromised patients. Our aim was to compare CT findings with microbiology and histopathology in the diagnosis of fungal rhinosinusitis. Methods: CT images of paranasal sinuses of 2500 patients examined during a 24-month period were reviewed retrospectively. In addition, a database search for the same period was performed for all patients reported with microbiological or histopathological findings consistent with fungal sinusitis. Results: Fifteen patients with complicated sinusitis fulfilled the criteria set for CT findings suggestive of a fungal ball. Fungal sinusitis with the formation of a fungal ball was confirmed in all 12 cases where additional diagnostics were performed. Eight further cases of complicated sinusitis with filamentous fungus findings from sinuses were identified by a microbiology database search. In two of these cases, a fungal ball had been found at sinus surgery but six cases were diagnosed with fungal sinusitis without fungal ball. No further cases could be identified in the histopathology database search. The 20 cases with complicated sinusitis and evidence of fungal involvement consisted of thirteen cases with a fungal ball and seven cases of fungal sinusitis without a fungal ball. The predominant pathogen in both groups was Aspergillus fumigatus. Significantly more patients without a fungal ball were immunocompromised than patients with a fungal ball (p=0.0047). Five patients had nasal polyps, four of whom had sinusitis without fungal ball in contrast to one patient of the 13 with fungal ball (p=0.0307). The radiological, laboratory and clinical findings of the six immunocompromised patients without a fungal ball did not meet the diagnostic criteria set for allergic fungal sinusitis or any other type of fungal sinusitis. The presence of calcification in CT was found to be very specific for sinusitis with fungal ball (p=0.0128). Conclusions: Direct microscopy on sinus specimens using the fluorescent enhancer Calcofluor white was more sensitive than culture or histopathology in detecting fungi in sinus samples. The specificity of CT was found to be very high for detecting sinusitis with fungal ball. Fungal sinusitis without fungal ball but not meeting the diagnostic criteria for any specific type of fungal sinusitis may present a form of sinus mucositis caused by filamentous fungi in immunocompromised patients.
Full conference title:
4th Advances Against Aspergillosis
- AAA 4th (2010)