PMC6436000_01
Sphenoidal sinus osteomyelitis. . A) Fat suppressed T2 image in the axial plane showing sphenoid sinusitis, altered signal intensity in adjacent bones with expansion of right cavernous sinus by soft tissue (white arrows). B) Subtracted post contrast T1 image in the axial plane showing enhancing soft tissue thickening in the right cavernous sinus with extension to the orbital apex. There is an enhancement of the adjacent right optic nerve and the right half of the optic chiasma shows abnormal signal intensity (white arrows). C) Post contrast T1 image in the coronal plane shows a striking asymmetry of the right cavernous sinus due to enhancing soft tissue within it. Note the narrowed caliber of the cavernous segment of the right internal carotid artery compared to the left (white arrow).
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F1
Areas of altered bone marrow signal intensity with adjacent bone destruction were observed involving the walls of the sphenoid sinus (Figure 1A (Fig. 1)), bilateral posterior clenoid processes, right anterior clenoid process, dorsum sella, the proximal half of clivus, and the right petrous apex region. Posterior one third of the intraorbital portion and of the intracanalicular portion of the right optic nerve, the right half of the optic chiasm was enlarged and showed hyperintense signal intensity on subtracted post contrast T1 image (Figure 1B (Fig. 1)). T1 image in the coronal plane showed an asymmetry of the right cavernous sinus due to enhancing soft tissue within it. (Figure 1C (Fig. 1)). These imaging features were suggestive of fungal sphenoid sinusitis with osteomyelitis involving the right cavernous sinus, adjacent dura, right optic nerve pathway, and pituitary gland.