Fungus ball of the paranasal sinuses: Report of two cases and literature review

Summary Introduction: Fungal ball of the sinuses is a not invasive infection that if characterizes for its chronicity, being the majority related with previous endodontic treatment. Affect mainly the breasts to maxillary; even so all the breasts can be involved. The main etiological agent is the Aspergillus spp. The computed tomography, had to characteristic the radiological presentations, suggests the diagnosis that is carried through definitively through histopathological analyses. The treatment standard-gold is the sinus surgery with average meatal antrostomy. Objective: Reporting two cases of fungal ball of the sinuses and to stand out important aspects of this pathology. Story of the Cases: Case 1) Patient of the feminine sex, 78 years old, presented itself with complaints of face pain has 6 months and previous history of endodontic treatment. To the physical examination it was evidenced purulent secretion presence in left average meatus. Ray X presented complete veiling of the breasts to maxillary left, while the computed tomography showed injury calcified in this place. Sinusotomy was become fulfilled that evolved well. Case 2) Patient of the feminine sex, 70 years old, looked attendance for history of sinusitis of repetition. To the physical examination no particularity was not perceived. The computed tomography, as well as the magnetic resonance, detected thickening of the mucous wall of the breasts to maxillary left, beyond a calcified mass. It was become fulfilled same sequence of treatment and the patient also evolved well. Final Considerations: The fungal infection must be considered in the patients who if present with chronic sinusitis, that they do not answer to the antibiotic use and that they possess history of endodontic manipulation.

Download Full-text

CLINICAL AND RADIOLOGICAL FEATURES OF THE MAXILLARY SINUS IN PATIENTS AFTER REMOVAL OF FUNGAL BALL AND THEIR IMPACT ON THE FREQUENCY OF SUBANTRAL BONE AUGMENTATION COMPLICATIONS.

Клінічна та профілактична медицина ◽

10.31612/2616-4868.3(17).2021.02 ◽

2021 ◽

Vol 3 (17) ◽

pp. 13-20

Author(s):

Ya.V. Shkorbotun

Keyword(s):

Computed Tomography ◽

Maxillary Sinus ◽

Tissue Injury ◽

Sinus Surgery ◽

Middle Meatus ◽

Bone Augmentation ◽

Endoscopic Removal ◽

Fungal Ball ◽

Dental Implantation ◽

Maxillary Sinuses

Abstract. The mucoperiostitis and local osteitis are radiological symptoms of the fungal ball of the maxillary sinuses. The condition of the mucoperiosteum and the adjacent bone in the alveolar bay of the maxillary sinus predict the results of dental implantation and subantral augmentation. The endoscopic access to the sinus by the antrostomy in the middle meatus and infraturbinal have been used to avoid excessive tissue injury during the removal of the fungal ball. Aim: To assess the condition of the bone and mucoperiosteum of the maxillary sinus in patients with fungal ball after rhinosurgery by the antrostomy with additional osteoplastic infraturbinal access. Methods and materials: The data of 102 patients who underwent surgery for the fungal ball of the maxillary sinus were analyzed, and subsequently - subantral bone augmentation and dental implantation were performed. In patients of the first group (67 people) - endoscopic intervention was performed by antrostomy in the middle meatus, and in 2nd group (35 people) - additional osteoplastic infraturbinal access was used. Result: Computed tomography data were evaluated before endoscopic sinus surgery and before subantral augmentation. The frequency of signs and severity of osteitis according to Kannedy Osteitis Score, after the intervention did not change significantly, and was established as 0.90 ± 0.07 in patients of group №1 and 0.77 ± 0.08 – group №2. The total frequency of complications with subantral augmentation in the comparison groups was 17.91 ± 4.68% and 17.14 ± 6.37%, respectively. Symptoms of osteitis in patients with fungal ball of the maxillary sinus after endoscopic removal, in the first 4 - 6 months of observation tend to regress, but do not disappear. Conclusions: The incidence of osteitis in computed tomography in patients with maxillary sinuses fungal balls in 4.8 months after endoscopic removal tends to decrease and is 77.61 ± 5.09% when approach through the middle meatus and 74.29 ± 7, 39% in patients with combined infraturbinal approach. The use of additional infraturbinal approach in patients with a fungal ball does not adversely affect the results of subsequent subantral augmentation and dental implantation.

Download Full-text

Evaluation of Prognostic Factors in Endoscopic Sinus Surgery

American Journal of Rhinology ◽

10.2500/105065897781751947 ◽

1997 ◽

Vol 11 (3) ◽

pp. 187-192 ◽

Cited By ~ 48

Author(s):

Steven C. Marks ◽

Falah Shamsa

Keyword(s):

Computed Tomography ◽

Revision Surgery ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Stage Of Disease ◽

Surgery Outcome ◽

Percent Improvement ◽

Subsequent Revision ◽

History Of ◽

Poor Outcomes

A retrospective analysis of 115 consecutive patients who underwent endoscopic sinus surgery for chronic sinusitis was conducted to evaluate the effect on outcome of variables including previous sinus surgery, allergy, asthma, and computed tomography stage of disease. Outcome was assessed in each patient by a survey in which the patient rated the benefit of surgery in terms of percent improvement in different symptoms compared with symptoms before surgery. Outcome was also assessed by the need for revision surgery and the presence of endoscopic criteria for failure. The results indicate that allergy and previous sinus surgery are associated with lower individual symptom scores, but no variable was associated with overall symptomatic failure. Previous sinus surgery was strongly associated with the need for subsequent revision surgery. The computed tomography stage was strongly associated with endoscopic evidence of failure. In conclusion, both history of previous sinus surgery and computed tomography stage of disease are correlated to poor outcomes after endoscopic sinus surgery.

Download Full-text

Post-traumatic arachnoid cyst without neurological sequels

Romanian Neurosurgery ◽

10.33962/roneuro-2020-043 ◽

2020 ◽

pp. 294-297

Author(s):

Raphael Oliveira Ramos Franco Netto ◽

João Italo Fortaleza De Melo ◽

Victor Augusto Ramos Fernandes ◽

Juliana de Almeida Rodrigues Franco Netto ◽

Leonardo Gattass Ferreira ◽

...

Keyword(s):

Computed Tomography ◽

Physical Examination ◽

Arachnoid Cyst ◽

Neurological Deficit ◽

Nervous Tissue ◽

Three Dimensions ◽

Anterior Extension ◽

History Of ◽

Post Traumatic ◽

The Brain

An eight-year-old male patient was admitted to the hospital with a history of left median paramedian frontal craniectomy due to car trauma at six months of age. Axial computed tomography of the skull with reconstruction in three dimensions revealed an arachnoid cyst with slight herniation of the brain in the frontal lobe, leading to protrusion against the skullcap, causing dilation of the ex-vacuum of the anterior extension of the homolateral lateral ventricle. He presented asymmetrical lateral ventricles, a reduced base cistern, and a slightly ectatic IV centred ventricle. After the physical examination, no neurological deficit was found, despite the changes identified in the images. It is believed that such conditions may progressively worsen with the development and maturation of nervous tissue over the age of the assessed child. To confirm this, specialized monitoring is of fundamental importance.

Download Full-text

Endoscopic Findings of Fungal Ball in the Mucocele After Endonasal Transsphenoidal Surgery

Ear Nose & Throat Journal ◽

10.1177/0145561319867669 ◽

2019 ◽

pp. 014556131986766

Author(s):

Jong Seung Kim ◽

Eun Jung Lee

Keyword(s):

Transsphenoidal Surgery ◽

Sphenoid Sinus ◽

Pituitary Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Fungal Ball ◽

Endoscopic Findings ◽

Transseptal Approach ◽

History Of ◽

The Right

A 51-year-old woman with headache was referred to our hospital. She had a history of endonasal pituitary surgery 22 years prior and hypertension 10 years prior. The endonasal transsphenoidal pituitary approach was performed via microscopic transseptal approach. Nasal endoscopy revealed whitish cystic wall protruded from the right sphenoid sinus. Functional endoscopic sinus surgery was performed under general anesthesia. After incision of the right sphenoid ostium, yellowish mucoid discharge in the right sphenoid sinus was pushed out from the sphenoid sinus. Histopathology confirmed fungal ball in the sphenoid sinus, which is consistent with aspergillosis sinus. The presence of fungal ball and mucocele are rarely reported, but mucocele and fungal ball found after pituitary surgery are the first and therefore unique in this case.

Download Full-text

Isolated sphenoid polyp: a cause of headache

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20185323 ◽

2018 ◽

Vol 5 (1) ◽

pp. 228

Author(s):

J. R. Galagali ◽

Roohie Singh ◽

Santosh Kumar

Keyword(s):

Computed Tomography ◽

Sphenoid Sinus ◽

Incidental Finding ◽

Correct Diagnosis ◽

Clinical Situation ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Sinus Disease ◽

Nasal Mass ◽

History Of

Isolated sphenoid sinus polyp is a rare clinical situation. It might be an incidental finding while investigating a case of headache. We report a case of 21 years old male who presented with history of headache since 6 months. Diagnostic nasal endoscopy (DNE) revealed a right nasal mass which was confirmed by computed tomography (CT) of paranasal sinuses (PNS). The patient underwent Functional endoscopic sinus surgery (FESS).This paper emphasizes importance of correct diagnosis and consideration of sphenoid sinus disease as differential diagnosis of patients with headache.

Download Full-text

Ethmoid Pneumocele Presenting with Exophthalmos 15 Years after Endoscopic Sinus Surgery

Allergy & Rhinology ◽

10.2500/ar.2015.6.0123 ◽

2015 ◽

Vol 6 (2) ◽

pp. ar.2015.6.0123

Author(s):

Michelle Song ◽

Sun M. Ahn ◽

Douglas R. Reh ◽

Josef Shargorodsky

Keyword(s):

Computed Tomography ◽

Case Report ◽

Endoscopic Sinus Surgery ◽

Surgical Decompression ◽

Operative Approach ◽

Diagnostic Workup ◽

Sinus Surgery ◽

Postoperative Results ◽

Natural Position ◽

History Of

Introduction A pneumocele is an abnormal dilation of an air-containing sinus beyond the normal margins of bone, with associated bony thinning. A delayed ethmoid pneumocele after sinus surgery has not previously been reported. Methods A case report of a patient with a delayed ethmoid pneumocele after sinus surgery. The diagnostic workup, operative approach, and postoperative results were evaluated. Results A 57-year-old female with a history of endoscopic sinus surgery 15 years prior presented with right eye proptosis and severe orbital and facial pressure. A maxillofacial computed tomography showed a markedly expanded air-filled right anterior ethmoid space with a dehiscent lamina papyracea, consistent with a pneumocele. Marsupialization of the pneumocele as well as a revision ethmoidectomy were performed, with a visible return of the orbital contents to a more natural position. The patient experienced worsened diplopia immediately postoperatively that resolved within two weeks. Conclusions This case demonstrates that a pneumocele can present even years after endoscopic sinus surgery, and acute but temporary development or worsening of diplopia can result from surgical decompression of the pneumocele as the eye returns to its natural position.

Download Full-text

Fungus ball paranasal sinuses: pattern of histopathology and culture characteristics

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v49i20.315 ◽

2019 ◽

Vol 49 (20) ◽

Author(s):

Nugroho Suharsono

Keyword(s):

Aspergillus Niger ◽

Paranasal Sinus ◽

Paranasal Sinuses ◽

Histopathological Examination ◽

Morphological Characteristics ◽

Sinus Surgery ◽

Nasal Discharge ◽

Fungus Ball ◽

Methenamine Silver ◽

Fungus Balls

Background: Fungal infection of the nose and paranasal sinuses is an uncommon condition which is now being increasingly recognized. The clinical presentation is not specific with various symptoms such as nasal obstruction, purulent nasal discharge, facial pain, and chronic cough. Only unilaterality may alert the clinician. Purpose: To find the morphological characteristics of the fungus in patients with paranasal sinus fungus ball. Methods: A retrospective study of 13 paranasal sinus fungus balls cases which underwent endoscopic sinus surgery at Department of Otorhinolaryngology Head and Neck Surgery St. Vincentius A Paulo Hospital Surabaya from March, 2012 until December, 2013. Age, sex, histopathology and fungal cultur were analysed. Histopathologic sections of all the patients were stained with hematoxylin and eosin (H&E), and Gomori methenamine silver (GMS). The specimens were then cultured on Sabouraud dextrose agar plates and incubated at 30°C for 1 month. At the end of the incubation period, the samples were evaluated microscopically to detect fungi and identify their species. Results: The age reported of the 13 patients, was ranging from 36 to 63 years old. There was a significant female predominance, 10 female patients (76.92%) and 3 male patients (23.08%). Histopathological examination showed that most causative agents were Aspergillus species 92.31% (12/13). Culture test was positive for 69.23% (9/13). Aspergillus niger (61.54%, 8/13) is the most frequent fungus reported to cause fungus balls. Conclusion: Pattern of histopathologic on HE and GMS is very helpful and sensitive to identify fungi. The most common isolated mould in our study was Aspergillus niger.Keywords: fungus ball, histopathology and culture, Aspergillus nigerABSTRAK Latar Belakang: Infeksi jamur di hidung dan sinus paranasal merupakan kondisi yang jarang terjadi, namun kini lebih sering ditemukan. Gejala klinisnya tidak spesifik dapat berupa obstruksi hidung, sekret dari hidung, nyeri wajah, dan batuk kronis. Bila terjadi unilateral, patut diwaspadai oleh para klinisi. Tujuan: Untuk mengetahui karakteristik morfologi fungus yang didapati pada pasien sinusitis jamur yang kami teliti. Metode: Dilakukan penelitian retrospektif pada 13 pasien sinusitis jamur yang menjalani bedah sinus endoskopi di Departemen Otorinolaringologi-Kepala Leher Rumah Sakit St. Vincentius A Paulo Surabaya dari bulan Maret 2012 sampai dengan Desember 2013. Dilakukan analisis usia, jenis kelamin, histopatologi dan kultur jamur. Pewarnaan preparat histopatologi menggunakan Hematoxylin dan eosin (H&E) dan Gomori Methenamine Silver (GMS). Kemudian spesimen diletakkan pada piring agar Sabouraud dextrose, dan dilakukan inkubasi pada suhu 30°C selama satu bulan. Pada akhir masa inkubasi, sampel dievaluasi dengan mikroskop untuk mendeteksi jamur dan spesiesnya. Hasil: Didapati usia 13 penderita berkisar dari 36-63 tahun. Wanita lebih dominan sebanyak 10 penderita (76,92 %) dan 3 penderita laki-laki (23,08%). Hasil pemeriksaan histopatologi menunjukkan spesies Aspergillus sebagai penyebab utama (92,31%) pada 12 penderita (12/13).Tes kultur positif pada 69,23% (9/13). Jamur yang paling sering menyebabkan bola jamur pada sinus adalah Aspergillus niger (61,54%, 8/13). Kesimpulan: Pewarnaan preparat histopatologi menggunakan Hematoxylin dan eosin (H&E) dan Gomori Methenamine Silver (GMS) sangat berguna dan sensitif dalam mendeteksi adanya jamur. Jenis jamur yang paling banyak ditemukan pada penelitian kami adalah Aspergillus niger.

Download Full-text

Refractory Ascites as the Only Presenting Symptom of Chronic Calcified Constrictive Pericarditis: A Diagnostic Challenge

The Heart Surgery Forum ◽

10.1532/hsf98.2013251 ◽

2014 ◽

Vol 17 (1) ◽

pp. 42

Author(s):

Shi-Min Yuan

Keyword(s):

Computed Tomography ◽

Liver Cirrhosis ◽

Female Patient ◽

Constrictive Pericarditis ◽

Delayed Diagnosis ◽

Young Female ◽

Refractory Ascites ◽

Diagnostic Challenge ◽

Massive Ascites ◽

History Of

Extracardiac manifestations of constrictive pericarditis, such as massive ascites and liver cirrhosis, often cover the true situation and lead to a delayed diagnosis. A young female patient was referred to this hospital due to a 4-year history of refractory ascites as the only presenting symptom. A diagnosis of chronic calcified constrictive pericarditis was eventually established based on echocardiography, ultrasonography, and computed tomography. Cardiac catheterization was not performed. Pericardiectomy led to relief of her ascites. Refractory ascites warrants thorough investigation for constrictive pericarditis.

Download Full-text

Scopolamine fatal outcome in an inmate after buscopan® smoking

International Journal of Legal Medicine ◽

10.1007/s00414-021-02583-2 ◽

2021 ◽

Author(s):

Sabina Strano-Rossi ◽

Serena Mestria ◽

Giorgio Bolino ◽

Matteo Polacco ◽

Simone Grassi ◽

...

Keyword(s):

Computed Tomography ◽

Drug Abuse ◽

Muscarinic Receptors ◽

Histopathological Examination ◽

Fatal Outcome ◽

Post Mortem ◽

Butyl Bromide ◽

Cannabis Abuse ◽

Toxic Concentration ◽

History Of

AbstractScopolamine is an alkaloid which acts as competitive antagonists to acetylcholine at central and peripheral muscarinic receptors. We report the case of a 41-year-old male convict with a 27-year history of cannabis abuse who suddenly died in the bed of his cell after having smoked buscopan® tablets. Since both abuse of substances and recent physical assaults had been reported, we opted for a comprehensive approach (post-mortem computed tomography CT (PMCT), full forensic autopsy, and toxicology testing) to determine which was the cause of the death. Virtopsy found significant cerebral edema and lungs edema that were confirmed at the autopsy and at the histopathological examination. Scopolamine was detected in peripheral blood at the toxic concentration of 14 ng/mL in blood and at 263 ng/mL in urine, and scopolamine butyl bromide at 17 ng/mL in blood and 90 ng/mL in urine. Quetiapine, mirtazapine, lorazepam, diazepam, and metabolites and valproate were also detected (at therapeutic concentrations). Inmates, especially when they have a history of drug abuse, are at risk to use any substance they can find for recreational purposes. In prisons, active surveillance on the management and assumption of prescribed drugs could avoid fatal acute intoxication.

Download Full-text

Faecopneumothorax due to missing diaphragmatic hernia: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02606-3 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Resul Nusretoğlu ◽

Yunus Dönder

Keyword(s):

Computed Tomography ◽

Diaphragmatic Hernia ◽

Colon Resection ◽

Emergency Laparotomy ◽

Hernia Sac ◽

Case Presentation ◽

Abdominal Tenderness ◽

History Of ◽

Diaphragmatic Hernias ◽

Tomography Scan

Abstract Background Diaphragmatic hernias may occur as either congenital or acquired. The most important cause of acquired diaphragmatic hernias is trauma, and the trauma can be due to blunt or penetrating injury. Diaphragmatic hernia may rarely be seen after thoracoabdominal trauma. Case presentation A 54-year-old Turkish male patient admitted to the emergency department with abdominal pain and dyspnea ongoing for 2 days. He had general abdominal tenderness in all quadrants. He had a history of a stabbing incident in his left subcostal region 3 months ago without any pathological findings in thoracoabdominal computed tomography scan. New thoracoabdominal computed tomography showed a diaphragmatic hernia and fluid in the hernia sac. Due to respiratory distress and general abdominal tenderness, the decision to perform an emergency laparotomy was made. There was a 6 cm defect in the diaphragm. There were also necrotic fluids and stool in the hernia sac in the thorax colon resection, and an anastomosis was performed. The defect in the diaphragm was sutured. The oral regimen was started, and when it was tolerated, the regimen was gradually increased. The patient was discharged on the postoperative 11th day. Conclusions Acquired diaphragmatic hernia may be asymptomatic or may present with complications leading to sepsis. In this report, acquired diaphragmatic hernia and associated colonic perforation of a patient with a history of stab wounds was presented.

Download Full-text