PMC4376144_01
CT scan of the paranasal sinuses revealed left maxillary sinusitis with a calcified mass (arrows) and slight bone destruction, suggestive of maxillary sinus aspergilloma (A). Oblique sagittal thin-slab maximum intensity projection image revealed only a mild atherosclerotic change including calcifications and mild arterial wall irregularities without aneurysm formation (arrow; B).
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Initial computed tomography (CT) scan of the paranasal sinuses (Figure 1A) revealed left maxillary sinusitis with a calcified mass and slight bone destruction, suggestive of a maxillary sinus aspergilloma. On contrast-enhanced CT (Figure 1B), only a mild atherosclerotic change including calcifications and mild arterial wall irregularities without aneurysm formation was found in his intracranial arteries.
CT scan revealed diffuse subarachnoid hemorrhage mainly in the suprasellar cistern, left dominant bilateral Sylvian fissure and ambient cistern with intraventricular hemorrhage (A). Oblique sagittal thin-slab maximum intensity projection image revealed a wide-necked, shallow outpouching aneurysm in the superior wall of the left ICA (arrow; B).
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Initial CT images (Figure 2A) revealed diffuse subarachnoid hemorrhage, classified as Fisher group 4, and subsequent 3D-CTA (Figure 2B) revealed a blister-like aneurysm in the superior wall of the left ICA.
At autopsy, a ruptured aneurysm (arrow) was found in the left ICA (A, B).
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A rupture of the aneurysm in the superior wall of the left ICA was confirmed macroscopically (Figure 3A, 3B), and atherosclerosis was found in the left ICA microscopically.
Hematoxylin and eosin stain revealed destruction of the elastica interna and media, and numerous infiltrating inflammatory cells in the aneurysmal wall. Destruction of the wall structures was more severe in the inner membrane than in the outer one. Grocott's stain revealed Aspergillus hyphae in the inflamed areas of the arterial wall (inset).
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Grocott's staining revealed septate hyphae with acute-angle branching, morphologically consistent with aspergillus species, located in the inflamed areas of the arterial and aneurysmal walls (Figure 4).