PMC3390129_01
Brain window head CT showing incidental sphenoiditis with no intracranial pathology.
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F1
A routine brain window CT scan revealed incindental isolated sphenoiditis (Fig. 1).
Preoperative maxillofacial high-resolution computed tomography showing bilateral isolated sphenoiditis with osteosclerotic changes.
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F2
At the time of surgery, the patient presented with mild obtundation, confusion, and receptive aphasia (Fig. 2).
Head CT showing multiple brain abscesses within the left posterior parietal and temporal lobes, prominent vasogenic edema causing regional sulcal effacement.
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F3
A head CT (Fig. 3) with contrast and an MRI with contrast both revealed two lobulated, rim-enhancing lesions with surrounding edema and local mass effect in the left temporal lobe, suggestive of brain abscesses (Figs. 4 and 5).
Periodic acid schiff 100x. Branching pseudohyphae consistent with Candida spp., taken from a fungus ball removed from the sphenoid sinus.
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F5
The pathology report confirmed Candida infection (Fig. 5).
Follow-up MRI 4 months postoperatively. Surgical changes consistent with left temporal craniotomy and underlying left temporal encephalomalacia. Otherwise resolved sphenoiditis and fluid collections.
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F6
The patient made a full recovery postoperatively, with resolution of abscess and sinus findings on subsequent imaging (Fig. 6).