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Invasive Fungal Sinusitis
Nicholas A. Koontz, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Invasive fungal sinusitis
              • Acute invasive fungal rhinosinusitis (AIFRS)
              • Chronic invasive fungal rhinosinusitis (CIFRS)
              • Granulomatous invasive fungal rhinosinusitis (GIFRS)
            • Synonyms

              • AIFRS: Acute necrotizing FRS
              • GIFRS: Primary paranasal granuloma, indolent fungal sinusitis
            • Definitions

              • AIFRS: Rapidly progressive (hours to days), transmucosal fungal sinus infection in immunocompromised patients with vascular, bone, soft tissues, orbit, & intracranial invasion resulting in "dry gangrene"
              • CIFRS: Indolent (weeks to months) infection with dematiaceous > hyaline molds or mucormycoses; associated with less severe immunocompromise than AIFRS
              • GIFRS: Primarily found in Sudan, India, Pakistan, & Saudi Arabia; gradual onset fungal invasion of orbit, nose, paranasal sinuses, or maxilla with characteristic noncaseating granulomas

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Angiographic 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. Fu KA et al: Basilar artery territory stroke secondary to invasive fungal sphenoid sinusitis: a case report and review of the literature. Case Rep Neurol. 7(1):51-8, 2015
                                            2. Gupta R et al: Allergic fungal rhino sinusitis with granulomas: a new entity? Med Mycol. 53(6):569-75, 2015
                                            3. Kim JH et al: The prognostic value of gadolinium-enhanced magnetic resonance imaging in acute invasive fungal rhinosinusitis. J Infect. 70(1):88-95, 2015
                                            4. Middlebrooks EH et al: Acute invasive fungal rhinosinusitis: a comprehensive update of CT findings and design of an effective diagnostic imaging model. AJNR Am J Neuroradiol. 36(8):1529-35, 2015
                                            5. Rupa V et al: Current therapeutic protocols for chronic granulomatous fungal sinusitis. Rhinology. 53(2):181-7, 2015
                                            6. Lee DH et al: Invasive fungal sinusitis of the sphenoid sinus. Clin Exp Otorhinolaryngol. 7(3):181-7, 2014
                                            7. Piromchai P et al: Impact of treatment time on the survival of patients suffering from invasive fungal rhinosinusitis. Clin Med Insights Ear Nose Throat. 7:31-4, 2014
                                            8. Cornelius RS et al: ACR appropriateness criteria sinonasal disease. J Am Coll Radiol. 10(4):241-6, 2013
                                            9. Monroe MM et al: Invasive fungal rhinosinusitis: a 15-year experience with 29 patients. Laryngoscope. 123(7):1583-7, 2013
                                            10. Mossa-Basha M et al: The many faces of fungal disease of the paranasal sinuses: CT and MRI findings. Diagn Interv Radiol. 19(3):195-200, 2013
                                            11. Seo J et al: Cervicofacial tissue infarction in patients with acute invasive fungal sinusitis: prevalence and characteristic MR imaging findings. Neuroradiology. 55(4):467-73, 2013
                                            12. Turner JH et al: Survival outcomes in acute invasive fungal sinusitis: a systematic review and quantitative synthesis of published evidence. Laryngoscope. 123(5):1112-8, 2013
                                            13. Gorovoy IR et al: Fungal rhinosinusitis and imaging modalities. Saudi J Ophthalmol. 26(4):419-26, 2012
                                            14. Thompson GR 3rd et al: Fungal disease of the nose and paranasal sinuses. J Allergy Clin Immunol. 129(2):321-6, 2012
                                            15. Chakrabarti A et al: Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies. Laryngoscope. 119(9):1809-18, 2009
                                            16. Das A et al: Spectrum of fungal rhinosinusitis; histopathologist's perspective. Histopathology. 54(7):854-9, 2009
                                            17. Deshazo RD: Syndromes of invasive fungal sinusitis. Med Mycol. 47 Suppl 1:S309-14, 2009
                                            18. Süslü AE et al: Acute invasive fungal rhinosinusitis: our experience with 19 patients. Eur Arch Otorhinolaryngol. 266(1):77-82, 2009
                                            19. Epstein VA et al: Invasive fungal sinusitis and complications of rhinosinusitis. Otolaryngol Clin North Am. 41(3):497-524, viii, 2008
                                            20. Ingley AP et al: Orbital and cranial nerve presentations and sequelae are hallmarks of invasive fungal sinusitis caused by Mucor in contrast to Aspergillus. Am J Rhinol. 22(2):155-8, 2008
                                            21. Aribandi M et al: Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics. 27(5):1283-96, 2007
                                            22. Granville L et al: Fungal sinusitis: histologic spectrum and correlation with culture. Hum Pathol. 35(4):474-81, 2004
                                            23. Parikh SL et al: Invasive fungal sinusitis: a 15-year review from a single institution. Am J Rhinol. 18(2):75-81, 2004
                                            24. DelGaudio JM et al: Computed tomographic findings in patients with invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 129(2):236-40, 2003
                                            25. Howells RC et al: Usefulness of computed tomography and magnetic resonance in fulminant invasive fungal rhinosinusitis. Am J Rhinol. 15(4): 255-61, 2001
                                            26. Hurst RW et al: Mycotic aneurysm and cerebral infarction resulting from fungal sinusitis: imaging and pathologic correlation. AJNR Am J Neuroradiol. 22(5): 858-63, 2001
                                            27. Gillespie MB et al: An algorithmic approach to the diagnosis and management of invasive fungal rhinosinusitis in the immunocompromised patient. Otolaryngol Clin North Am. 33(2): 323-34, 2000
                                            28. Hunt SM et al: Invasive fungal sinusitis in the acquired immunodeficiency syndrome. Otolaryngol Clin North Am. 33(2): 335-47, 2000
                                            29. Lund VJ et al: Fungal rhinosinusitis. J Laryngol Otol. 114(1): 76-80, 2000
                                            30. Fatterpekar G et al: Fungal diseases of the paranasal sinuses. Semin Ultrasound CT MR. 20(6): 391-401, 1999
                                            31. Silverman CS et al: Periantral soft-tissue infiltration and its relevance to the early detection of invasive fungal sinusitis: CT and MR findings. AJNR Am J Neuroradiol. 19(2): 321-5, 1998
                                            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

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Invasive fungal sinusitis
                                                        • Acute invasive fungal rhinosinusitis (AIFRS)
                                                        • Chronic invasive fungal rhinosinusitis (CIFRS)
                                                        • Granulomatous invasive fungal rhinosinusitis (GIFRS)
                                                      • Synonyms

                                                        • AIFRS: Acute necrotizing FRS
                                                        • GIFRS: Primary paranasal granuloma, indolent fungal sinusitis
                                                      • Definitions

                                                        • AIFRS: Rapidly progressive (hours to days), transmucosal fungal sinus infection in immunocompromised patients with vascular, bone, soft tissues, orbit, & intracranial invasion resulting in "dry gangrene"
                                                        • CIFRS: Indolent (weeks to months) infection with dematiaceous > hyaline molds or mucormycoses; associated with less severe immunocompromise than AIFRS
                                                        • GIFRS: Primarily found in Sudan, India, Pakistan, & Saudi Arabia; gradual onset fungal invasion of orbit, nose, paranasal sinuses, or maxilla with characteristic noncaseating granulomas

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Angiographic 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. Fu KA et al: Basilar artery territory stroke secondary to invasive fungal sphenoid sinusitis: a case report and review of the literature. Case Rep Neurol. 7(1):51-8, 2015
                                                                                      2. Gupta R et al: Allergic fungal rhino sinusitis with granulomas: a new entity? Med Mycol. 53(6):569-75, 2015
                                                                                      3. Kim JH et al: The prognostic value of gadolinium-enhanced magnetic resonance imaging in acute invasive fungal rhinosinusitis. J Infect. 70(1):88-95, 2015
                                                                                      4. Middlebrooks EH et al: Acute invasive fungal rhinosinusitis: a comprehensive update of CT findings and design of an effective diagnostic imaging model. AJNR Am J Neuroradiol. 36(8):1529-35, 2015
                                                                                      5. Rupa V et al: Current therapeutic protocols for chronic granulomatous fungal sinusitis. Rhinology. 53(2):181-7, 2015
                                                                                      6. Lee DH et al: Invasive fungal sinusitis of the sphenoid sinus. Clin Exp Otorhinolaryngol. 7(3):181-7, 2014
                                                                                      7. Piromchai P et al: Impact of treatment time on the survival of patients suffering from invasive fungal rhinosinusitis. Clin Med Insights Ear Nose Throat. 7:31-4, 2014
                                                                                      8. Cornelius RS et al: ACR appropriateness criteria sinonasal disease. J Am Coll Radiol. 10(4):241-6, 2013
                                                                                      9. Monroe MM et al: Invasive fungal rhinosinusitis: a 15-year experience with 29 patients. Laryngoscope. 123(7):1583-7, 2013
                                                                                      10. Mossa-Basha M et al: The many faces of fungal disease of the paranasal sinuses: CT and MRI findings. Diagn Interv Radiol. 19(3):195-200, 2013
                                                                                      11. Seo J et al: Cervicofacial tissue infarction in patients with acute invasive fungal sinusitis: prevalence and characteristic MR imaging findings. Neuroradiology. 55(4):467-73, 2013
                                                                                      12. Turner JH et al: Survival outcomes in acute invasive fungal sinusitis: a systematic review and quantitative synthesis of published evidence. Laryngoscope. 123(5):1112-8, 2013
                                                                                      13. Gorovoy IR et al: Fungal rhinosinusitis and imaging modalities. Saudi J Ophthalmol. 26(4):419-26, 2012
                                                                                      14. Thompson GR 3rd et al: Fungal disease of the nose and paranasal sinuses. J Allergy Clin Immunol. 129(2):321-6, 2012
                                                                                      15. Chakrabarti A et al: Fungal rhinosinusitis: a categorization and definitional schema addressing current controversies. Laryngoscope. 119(9):1809-18, 2009
                                                                                      16. Das A et al: Spectrum of fungal rhinosinusitis; histopathologist's perspective. Histopathology. 54(7):854-9, 2009
                                                                                      17. Deshazo RD: Syndromes of invasive fungal sinusitis. Med Mycol. 47 Suppl 1:S309-14, 2009
                                                                                      18. Süslü AE et al: Acute invasive fungal rhinosinusitis: our experience with 19 patients. Eur Arch Otorhinolaryngol. 266(1):77-82, 2009
                                                                                      19. Epstein VA et al: Invasive fungal sinusitis and complications of rhinosinusitis. Otolaryngol Clin North Am. 41(3):497-524, viii, 2008
                                                                                      20. Ingley AP et al: Orbital and cranial nerve presentations and sequelae are hallmarks of invasive fungal sinusitis caused by Mucor in contrast to Aspergillus. Am J Rhinol. 22(2):155-8, 2008
                                                                                      21. Aribandi M et al: Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics. 27(5):1283-96, 2007
                                                                                      22. Granville L et al: Fungal sinusitis: histologic spectrum and correlation with culture. Hum Pathol. 35(4):474-81, 2004
                                                                                      23. Parikh SL et al: Invasive fungal sinusitis: a 15-year review from a single institution. Am J Rhinol. 18(2):75-81, 2004
                                                                                      24. DelGaudio JM et al: Computed tomographic findings in patients with invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 129(2):236-40, 2003
                                                                                      25. Howells RC et al: Usefulness of computed tomography and magnetic resonance in fulminant invasive fungal rhinosinusitis. Am J Rhinol. 15(4): 255-61, 2001
                                                                                      26. Hurst RW et al: Mycotic aneurysm and cerebral infarction resulting from fungal sinusitis: imaging and pathologic correlation. AJNR Am J Neuroradiol. 22(5): 858-63, 2001
                                                                                      27. Gillespie MB et al: An algorithmic approach to the diagnosis and management of invasive fungal rhinosinusitis in the immunocompromised patient. Otolaryngol Clin North Am. 33(2): 323-34, 2000
                                                                                      28. Hunt SM et al: Invasive fungal sinusitis in the acquired immunodeficiency syndrome. Otolaryngol Clin North Am. 33(2): 335-47, 2000
                                                                                      29. Lund VJ et al: Fungal rhinosinusitis. J Laryngol Otol. 114(1): 76-80, 2000
                                                                                      30. Fatterpekar G et al: Fungal diseases of the paranasal sinuses. Semin Ultrasound CT MR. 20(6): 391-401, 1999
                                                                                      31. Silverman CS et al: Periantral soft-tissue infiltration and its relevance to the early detection of invasive fungal sinusitis: CT and MR findings. AJNR Am J Neuroradiol. 19(2): 321-5, 1998