Imaging Science in Dentistry

Korean Academy of Oral and Maxillofacial Radiology (대한영상치의학회)
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Characteristic features of fungus ball in the maxillary sinus and the location of intralesional calcifications on computed tomographic images: A report of 2 cases

  • Lee, Jae-Hoon (Department of Otolaryngology, Institute of Wonkwang Medical Science, School of Medicine, Wonkwang University) ;
  • Lee, Byung-Do (Department of Oral and Maxillofacial Radiology and Research Institute of Dental Education, College of Dentistry, Wonkwang University)
  • Received : 2020.07.13
  • Accepted : 2020.10.16
  • Published : 2020.12.31
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Abstract

This report presents 2 cases of sinus fungus ball and describes the characteristic radiographic features of fungus ball in the maxillary sinus. Two female patients, aged 62 and 40 years, sought consultations at a dental hospital for the treatment of dental implants and tooth pain, respectively. Panoramic radiography and small field-of-view(FOV) cone-beam computed tomography (CBCT) did not provide detailed information for the radiographic diagnosis of fungus ball due to the limited images of the maxillary sinus. Additional paranasal sinus computed tomographic images showed the characteristic features of fungus ball, such as heterogeneous opacification and intralesional calcification of the maxillary sinus. The calcified materials of the fungus balls were located in the middle and superior regions of the maxillary sinus. It is necessary to use large-FOV CBCT for the detection of calcified materials in the upper maxillary sinus to confirm the diagnosis of fungus ball.

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References

  1. Chakrabarti A, Denning DW, Ferguson BJ, Ponikau J, Buzina W, Kita H, et al. Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies. Laryngoscope 2009; 119: 1809-18. https://doi.org/10.1002/lary.20520
  2. Ferguson BJ. Fungus balls of the paranasal sinuses. Otolaryngol Clin North Am 2000; 33: 389-98. https://doi.org/10.1016/S0030-6665(00)80013-4
  3. Yoon YH, Xu J, Park SK, Heo JH, Kim YM, Rha KS. A retrospective analysis of 538 sinonasal fungus ball cases treated at a single tertiary medical center in Korea (1996-2015). Int Forum Allergy Rhinol 2017; 7: 1070-5. https://doi.org/10.1002/alr.22007
  4. Huang Z, Xu H, Xiao N, Li Y, Dong Y, Li Y, et al. Predictive significance of radiographic density of sinus opacity and bone thickness in unilateral maxillary sinus mycetoma. ORL J Otorhinolaryngol Relat Spec 2019; 81: 111-20. https://doi.org/10.1159/000496829
  5. Seo YJ, Kim J, Kim K, Lee JG, Kim CH, Yoon JH. Radiologic characteristics of sinonasal fungus ball: an analysis of 119 cases. Acta Radiol 2011; 52: 790-5. https://doi.org/10.1258/ar.2011.110021
  6. deShazo RD, O'Brien M, Chapin K, Soto-Aguilar M, Swain R, Lyons M, et al. Criteria for the diagnosis of sinus mycetoma. J Allergy Clin Immunol 1997; 99: 475-85. https://doi.org/10.1016/S0091-6749(97)70073-3
  7. Grosjean P, Weber R. Fungus balls of the paranasal sinuses: a review. Eur Arch Otorhinolaryngol 2007; 264: 461-70. https://doi.org/10.1007/s00405-007-0281-5
  8. Shokri A, Faradmal MJ, Hekmat B. Correlations between anatomical variations of the nasal cavity and ethmoidal sinuses on cone-beam computed tomography scans. Imaging Sci Dent 2019; 49: 103-13. https://doi.org/10.5624/isd.2019.49.2.103
  9. Vestin Fredriksson M, Öhman A, Flygare L, Tano K. When maxillary sinusitis does not heal: findings on CBCT scans of the sinuses with a particular focus on the occurrence of odontogenic causes of maxillary sinusitis. Laryngoscope Investig Otolaryngol 2017; 2: 442-6. https://doi.org/10.1002/lio2.130
  10. Dillenseger JP, Gros CI, Sayeh A, Rasamimanana J, Lawniczak F, Leminor JM, et al. Image quality evaluation of small FOV and large FOV CBCT devices for oral and maxillofacial radiology. Dentomaxillofac Radiol 2017; 46: 20160285. https://doi.org/10.1259/dmfr.20160285
  11. Tang L, Zhou XD, Wang Y, Zhang L, Zheng QH, Huang DM. Detection of vertical root fracture using cone beam computed tomography: report of two cases. Dent Traumatol 2011; 27: 484-8. https://doi.org/10.1111/j.1600-9657.2011.01030.x
  12. Nicolai P, Lombardi D, Tomenzoli D, Villaret AB, Piccioni M, Mensi M, et al. Fungus ball of the paranasal sinuses: experience in 160 patients treated with endoscopic surgery. Laryngoscope 2009; 119: 2275-9. https://doi.org/10.1002/lary.20578
  13. Tsai TL, Guo YC, Ho CY, Lin CZ. The role of ostiomeatal complex obstruction in maxillary fungus ball. Otolaryngol Head Neck Surg 2006; 134: 494-8. https://doi.org/10.1016/j.otohns.2005.10.009
  14. Han DH, An SY, Kim SW, Kim DY, Rhee CS, Lee CH, et al. Primary and secondary fungal infections of the paranasal sinuses: clinical features and treatment outcomes. Acta Otolaryngol 2007; 127 Suppl 558: 78-82.
  15. Ni Mhurchu E, Ospina J, Janjua AS, Shewchuk JR, Vertinsky AT. Fungal rhinosinusitis: a radiological review with intraoperative correlation. Can Assoc Radiol J 2017; 68: 178-86. https://doi.org/10.1016/j.carj.2016.12.009
  16. Yoon JH, Na DG, Byun HS, Koh YH, Chung SK, Dong HJ. Calcification in chronic maxillary sinusitis: comparison of CT findings with histopathologic results. AJNR Am J Neuroradiol 1999; 20: 571-4.
  17. Braun JJ, Bourjat P. CT imaging of fungal and nonfungal caseous sinusitis. A report of 50 cases. J Radiol 2000; 81: 227-31.
  18. Aribandi M, McCoy VA, Bazan C III. Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics 2007; 27: 1283-96. https://doi.org/10.1148/rg.275065189
  19. Dufour X, Kauffmann-Lacroix C, Ferrie JC, Goujon JM, Rodier MH, Karkas A, et al. Paranasal sinus fungus ball and surgery: a review of 175 cases. Rhinology 2005; 43: 34-9.
  20. Dufour X, Kauffmann-Lacroix C, Ferrie JC, Goujon JM, Rodier MH, Klossek JM. Paranasal sinus fungus ball: epidemiology, clinical features and diagnosis. A retrospective analysis of 173 cases from a single medical center in France, 1989-2002. Med Mycol 2006; 44: 61-7.
  21. Kim JS, So SS, Kwon SH. The increasing incidence of paranasal sinus fungus ball: a retrospective cohort study in two hundred forty-five patients for fifteen years. Clin Otolaryngol 2017; 42: 175-9. https://doi.org/10.1111/coa.12588
  22. Lim HS, Yoon YH, Xu J, Kim YM, Rha KS. Isolated sphenoid sinus fungus ball: a retrospective study conducted at a tertiary care referral center in Korea. Eur Arch Otorhinolaryngol 2017; 274: 2453-9. https://doi.org/10.1007/s00405-017-4468-0
  23. Killeen DE, Sedaghat AR, Cunnane ME, Gray ST. Objective radiographic density measurements of sinus opacities are not strong predictors of noninvasive fungal disease. Am J Rhinol Allergy 2014; 28: 483-6. https://doi.org/10.2500/ajra.2014.28.4104
  24. Stammberger H, Jakse R, Beaufort F. Aspergillosis of the paranasal sinuses x-ray diagnosis, histopathology, and clinical aspects. Ann Otol Rhinol Laryngol 1984; 93: 251-6. https://doi.org/10.1177/000348948409300313
  25. Jiang Z, Zhang K, Huang W, Yuan Q. A preliminary study on sinus fungus ball with microCT and X-ray fluorescence technique. PLoS One 2016; 11: e0148515. https://doi.org/10.1371/journal.pone.0148515
  26. Zinreich SJ, Kennedy DW, Malat J, Curtin HD, Epstein JI, Huff LC, et al. Fungal sinusitis: diagnosis with CT and MR imaging. Radiology 1988; 169: 439-44. https://doi.org/10.1148/radiology.169.2.3174990
  27. Chang T, Teng MM, Wang SF, Li WY, Cheng CC, Lirng JF. Aspergillosis of the paranasal sinuses. Neuroradiology 1992; 34: 520-3. https://doi.org/10.1007/BF00598965
  28. Cha H, Song Y, Bae YJ, Won TB, Kim JW, Cho SW, et al. Clinical characteristics other than intralesional hyperdensity may increase the preoperative diagnostic accuracy of maxillary sinus fungal ball. Clin Exp Otorhinolaryngol 2020; 13: 157-63. https://doi.org/10.21053/ceo.2019.00836
  29. Dhong HJ, Jung JY, Park JH. Diagnostic accuracy in sinus fungus balls: CT scan and operative findings. Am J Rhinol 2000; 14: 227-31. https://doi.org/10.2500/105065800779954446