Aspergillus sinusitis: clinical aspects and treatment outcomes.

Seventy-two cases of Aspergillus sinusitis were analyzed during a period of 14 years from January 1980 through October 1993. There were 60 cases of primary type and 12 cases of secondary type. The maxillary and ethmoid sinuses were most commonly affected in both primary and secondary types. The sphenoid sinus was commonly involved in secondary type. Fourteen (23%) cases of primary type and 4 (33%) cases of secondary type demonstrated sinus wall destruction on computed tomography or magnetic resonance images. Seventy percent of primary type and all cases of secondary type showed focal or diffuse areas of increased attenuation in the soft tissue mass on computed tomography scans. Sixteen cases assessed by magnetic resonance imaging showed decreased signal intensities on T1-weighted images and markedly reduced signal intensities on T2-weighted images. Fifty-nine (98%) of 60 cases of primary type were noninvasive, and 1 was invasive. In secondary type, 10 (83%) of 12 patients had noninvasive disease. The most common coexisting disease in secondary aspergillosis was diabetes mellitus. Thickened mucosa with necrotic brownish green material, which was the most common finding in both types, was found in 33 patients with primary type and in 5 with secondary type. Surgery was performed in most cases, among which 4 patients received chemotherapy after surgery with amphotericin B with or without flucytosine. All patients were cured without recurrence during a mean follow-up period of 13 months.