PMC6159120_01
MRI examination: the right sphenoid sinus is filled with a soft tissue mass that appears hypointense on T2 weighted image (a) with some susceptibility blooming artefacts on T2* images (b) and is hyperintense on T1 weighted image; (c) on post-contrast MPRAGE T1 images (d) the mass did not enhance, whereas the inflammatory mucosa underwent Contrast Enhancement (CE).
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The right sphenoid sinus showed irregular and hypertrophic T2 prolonged hyperintensity of the mucosa with central hypointensity (Figure 1a); this could be best appreciated as low signal on T2* GRE images (Figure 1b), and hyperintensity on T1 weighted images (Figure 1c). After contrast injection, there was enhancement of the right sphenoid sinus mucosa but not its contents (Figure 1d). The left sphenoid sinus showed minimal T2 hyperintense mucosal thickening due to reactive inflammatory changes but no evidence of left sphenoidal sinus disease or extracompartmental extension. To rule out the involvement of the surrounding neurovascular structures and bone infiltration, i.v. administration of paramagnetic contrast medium was injected.
Axial CT image shows complete opacification of right sphenoid sinus with central calcified streaks. The bony wall appears bowed, sclerotic and thickened, without any signs of erosion or destruction.
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T2* blooming artefacts on MRI) and sclerotic bone wall without continuity into the cortical bone(Figure 2). The other paranasal sinuses showed minimal mucosal thickening with tiny calcifications but no bony thickening, sclerosis or erosion.
Histopathological image reveals fungal hyphae consistent with Aspergillus fumigatus (H & E 22x).
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Histopathological examination confirmed the diagnosis of right sphenoidal sinus FB caused by Aspergillus fumigatus (Figure 3).
Axial postoperative CT image shows disappearance of right sphenoid sinus mass with only residual mucosal thickening, while sclerosis, thickening and bowing of right sphenoid sinus bony walls were still present with no evidence of dehiscence.
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Postoperatively, the patient clinically improved with gradual relief of her previous headache; a postoperative CT scan showed disappearance of the previously described right sphenoidal mass with no evidence of residual pathological tissue (Figure 4).