Invasive Fungal Rhinosinusitis 1
Claim CME CreditPOINT OF CARE INFORMATION
This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
CME Advisory Committee Disclosure:
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CA0089-Invasive Fungal Rhinosinusitis 1
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CA0089-Invasive Fungal Rhinosinusitis 1
Case ReportHistory
Exam
Prior Study
Findings
Nasal Cavity and Nasolacrimal Canal and Sac
There is mucosal thickening in the nasal cavity but no clearly ulcerative abnormality is identified. There is an infiltrating process of the fat surrounding the nasolacrimal sac that extends into the pre-septal soft tissues as well as edema in the adjacent post-septal soft tissues of the orbit mainly medially and inferiorly.
There clear evidence of bone erosion along the mesial aspect of the lacrimal bone as it borders the lacrimal sac and between it and the anterior most aspect of the ethmoid complex.
There is mucoperiosteal thickening in the entire right middle meatus extending to the posterior aspect of the middle turbinate attachment and into the sphenopalatine foramen that continues laterally to infiltrate the fat in the pterygopalatine fossa. There is also subtle evidence of extension of this infiltration to the fat pad posterior to the right maxillary sinus. These changes are highly suspicious for invasive fungal disease within the posterior nasal cavity.
Sinuses
There is mucoperiosteal thickening in all of the sinuses without obvious bone erosion. The intrasinus component of the disease is slightly more prominent on the right than left but is clearly bilateral. The fat planes in the canine fossa, anterior to the maxillary sinus and deep to the SMAS are not infiltrated.
There clear evidence of bone erosion along the mesial aspect of the lacrimal bone as it borders the lacrimal sac and between it and the anterior most aspect of the ethmoid complex.
The extraconal and, to a lesser extent, the intraconal orbital fat superior to the infraorbital canal clearly shows evidence of infiltration with stranding of the fat and increased density; similar findings are also present in the intra- and extraconal orbital fat along the medial orbital wall. The orbital apex and the superior and inferior orbital fissures are not infiltrated.
The fat pad posterior to the maxillary sinus shows evidence of involvement especially adjacent and just posterior to the pterygopalatine fossa when compared to the similar anatomic location on the left side.
Nasopharynx
There is no evidence of an infiltrating process in the nasopharynx.
Other Findings
The visualized portions of the brain are normal for the patient’s age.
