Howells R C, Ramadan H H
Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown 26506-9200, USA.
Am J Rhinol. 2001 Jul-Aug;15(4):255-61.
Fulminant invasive fungal rhinosinusitis is an aggressive, destructive process most commonly affecting the immunocompromised host. Although frequently fatal, prognosis is related directly to early recognition and aggressive treatment. Various reports advocate computed tomography (CT) scanning as the study of choice in evalucating suspected invasive fungal disease, reserving magnetic resonance imaging (MRI) for select cases. Others report lack of correlation between CT and surgical or pathological findings. Our aim wasq to investigate the usefulness of CT and MR in the diagnosis of invasive fungal rhinosinusitis. We retrospectively reviewed four cases of biopsy-proven invasive disease. Correlations between radiographic, endoscopic, and surgical findings were investigated. Rhizopus species were detected in three cases and mixed Mucor and Aspergillus species in another. Superimposed bacterial sinusitis was confirmed in all cases. CT findings were nonspecific, revealing pansinusitis; no bone destruction or intracranial extension was noted. Mild orbital cellulitis was noted in one case. Anterior rhinoscopy revealed nonviable tissue in two patients. Nasal endoscopy later confirmed tissue ischemia in a third patient, whereas a final patient had normal findings on both exams. Nonspecific findings resulted in delay of diagnosis by 48-72 hours in two patients with presumed bacterial sinusitis. MR revealed intracranial extension in two patients and better represented intraoperative findings. In conclusion, CT findings in invasive fungal rhinosinusitis may be nonspecific and underestimate extent of disease. A high index of suspicion and early endoscopic examination with biopsy are mandatory for evaluation. MRI may better represent disease progression and should be considered early.
暴发性侵袭性真菌性鼻-鼻窦炎是一种侵袭性、破坏性疾病，最常累及免疫功能低下的宿主。尽管该病常导致死亡，但其预后与早期识别和积极治疗直接相关。各种报告主张将计算机断层扫描（CT）作为评估疑似侵袭性真菌病的首选检查方法，仅在特定病例中使用磁共振成像（MRI）。其他报告称CT与手术或病理结果之间缺乏相关性。我们的目的是研究CT和MRI在侵袭性真菌性鼻-鼻窦炎诊断中的作用。我们回顾性分析了4例经活检证实的侵袭性疾病病例。研究了影像学、内镜检查和手术结果之间的相关性。3例检测到根霉属菌种，另1例检测到毛霉属和曲霉属混合菌种。所有病例均确诊合并细菌性鼻窦炎。CT表现无特异性，显示全鼻窦炎；未发现骨质破坏或颅内蔓延。1例患者出现轻度眶蜂窝织炎。前鼻镜检查发现2例患者有坏死组织。鼻内镜检查后来证实第3例患者组织缺血，而最后1例患者在两项检查中结果均正常。非特异性表现导致2例疑似细菌性鼻窦炎患者的诊断延迟48 - 72小时。MRI显示2例患者有颅内蔓延，且能更好地反映术中所见。总之，侵袭性真菌性鼻-鼻窦炎的CT表现可能无特异性，且会低估疾病范围。高度怀疑并早期进行内镜检查及活检对于评估至关重要。MRI可能能更好地反映疾病进展，应尽早考虑使用。
