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Allergic Fungal Sinusitis
H. Christian Davidson, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Allergic fungal sinusitis (AFS) or rhinosinusitis (AFRS)
              • Definitions

                • Severe form of chronic rhinosinusitis (CRS) with polyposis
                  •  Allergic response to fungi in susceptible individuals
                • Characterized by production of eosinophilic mucin containing noninvasive fungal hyphae
                • Considered to be minority subtype of sinonasal polyposis

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Uri N et al: Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis: diagnostic criteria. J Laryngol Otol. 127(9):867-71, 2013
                                            2. Champagne JP et al: Epidemiologic factors affect surgical outcomes in allergic fungal sinusitis. Laryngoscope. 120(11):2322-4, 2010
                                            3. Ponikau JU et al: Immunologic response to fungus is not universally associated with chronic rhinosinusitis. Otolaryngol Head Neck Surg. 143(5):607-10, 2010
                                            4. Reddy CE et al: Imaging of granulomatous and chronic invasive fungal sinusitis: comparison with allergic fungal sinusitis. Otolaryngol Head Neck Surg. 143(2):294-300, 2010
                                            5. Chakrabarti A et al: Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies. Laryngoscope. 119(9):1809-18, 2009
                                            6. Schubert MS: Allergic fungal sinusitis: pathophysiology, diagnosis and management. Med Mycol. 47 Suppl 1:S324-30, 2009
                                            7. Wise SK et al: Radiologic staging system for allergic fungal rhinosinusitis (AFRS). Otolaryngol Head Neck Surg. 140(5):735-40, 2009
                                            8. Aribandi M et al: Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics. 27(5):1283-96, 2007
                                            9. Ghegan MD et al: Socioeconomic factors in allergic fungal rhinosinusitis with bone erosion. Am J Rhinol. 21(5):560-3, 2007
                                            10. Ryan MW et al: Allergic fungal rhinosinusitis: diagnosis and management. Curr Opin Otolaryngol Head Neck Surg. 15(1):18-22, 2007
                                            11. Schubert MS: Allergic fungal sinusitis. Clin Allergy Immunol. 20:263-71, 2007
                                            12. Ghegan MD et al: Incidence of skull base and orbital erosion in allergic fungal rhinosinusitis (AFRS) and non-AFRS. Otolaryngol Head Neck Surg. 134(4):592-5, 2006
                                            13. Wise SK et al: Ethnic and gender differences in bone erosion in allergic fungal sinusitis. Am J Rhinol. 18(6):397-404, 2004
                                            14. Mukherji SK et al: Allergic fungal sinusitis: CT findings. Radiology. 207(2):417-22, 1998
                                            15. Manning SC et al: Computed tomography and magnetic resonance diagnosis of allergic fungal sinusitis. Laryngoscope. 107(2):170-6, 1997
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Allergic fungal sinusitis (AFS) or rhinosinusitis (AFRS)
                                                        • Definitions

                                                          • Severe form of chronic rhinosinusitis (CRS) with polyposis
                                                            •  Allergic response to fungi in susceptible individuals
                                                          • Characterized by production of eosinophilic mucin containing noninvasive fungal hyphae
                                                          • Considered to be minority subtype of sinonasal polyposis

                                                        IMAGING

                                                        • General Features

                                                          • CT Findings

                                                            • MR Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Uri N et al: Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis: diagnostic criteria. J Laryngol Otol. 127(9):867-71, 2013
                                                                                      2. Champagne JP et al: Epidemiologic factors affect surgical outcomes in allergic fungal sinusitis. Laryngoscope. 120(11):2322-4, 2010
                                                                                      3. Ponikau JU et al: Immunologic response to fungus is not universally associated with chronic rhinosinusitis. Otolaryngol Head Neck Surg. 143(5):607-10, 2010
                                                                                      4. Reddy CE et al: Imaging of granulomatous and chronic invasive fungal sinusitis: comparison with allergic fungal sinusitis. Otolaryngol Head Neck Surg. 143(2):294-300, 2010
                                                                                      5. Chakrabarti A et al: Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies. Laryngoscope. 119(9):1809-18, 2009
                                                                                      6. Schubert MS: Allergic fungal sinusitis: pathophysiology, diagnosis and management. Med Mycol. 47 Suppl 1:S324-30, 2009
                                                                                      7. Wise SK et al: Radiologic staging system for allergic fungal rhinosinusitis (AFRS). Otolaryngol Head Neck Surg. 140(5):735-40, 2009
                                                                                      8. Aribandi M et al: Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics. 27(5):1283-96, 2007
                                                                                      9. Ghegan MD et al: Socioeconomic factors in allergic fungal rhinosinusitis with bone erosion. Am J Rhinol. 21(5):560-3, 2007
                                                                                      10. Ryan MW et al: Allergic fungal rhinosinusitis: diagnosis and management. Curr Opin Otolaryngol Head Neck Surg. 15(1):18-22, 2007
                                                                                      11. Schubert MS: Allergic fungal sinusitis. Clin Allergy Immunol. 20:263-71, 2007
                                                                                      12. Ghegan MD et al: Incidence of skull base and orbital erosion in allergic fungal rhinosinusitis (AFRS) and non-AFRS. Otolaryngol Head Neck Surg. 134(4):592-5, 2006
                                                                                      13. Wise SK et al: Ethnic and gender differences in bone erosion in allergic fungal sinusitis. Am J Rhinol. 18(6):397-404, 2004
                                                                                      14. Mukherji SK et al: Allergic fungal sinusitis: CT findings. Radiology. 207(2):417-22, 1998
                                                                                      15. Manning SC et al: Computed tomography and magnetic resonance diagnosis of allergic fungal sinusitis. Laryngoscope. 107(2):170-6, 1997