Affected patients are typically immunocompromised and include patients with neutropenia, hematologic malignancies, poorly controlled diabetes, acquired immunodeficiency syndrome, and organ transplantation and patients on immunosuppressive therapy including systemic steroids and chemotherapy [4,5]. Aspergillus and Mucoraceae species are seen in most cases. Presenting symptoms are nonspecific and include fever, rhinorrhea, and diplopia, similar to those seen with ABRS. Clinicians should maintain a high index of suspicion for this diagnosis in immunocompromised patients with symptoms of ARS, orbital symptoms, and/or headache. Nasal endoscopy may demonstrate pale mucosa progressing to ulceration and necrosis [4]. Definitive diagnosis is made on biopsy with the identification of invasive fungi in the sinonasal mucosa, vessels, and bone [4]. Given the angioinvasive nature of the fungi, complications include thrombosis, dissection, and pseudoaneurysm formation of the intracranial arteries, thrombosis of the cavernous sinus, infarction, and hemorrhage [4,6]. Treatment typically includes both systemic antifungal medication and surgical debridement. Arteriography Craniofacial Arteriography may be performed for further characterization and confirmation of vascular complications of invasive fungal sinusitis detected by MRI, MRA, or CTA, including pseudoaneurysm formation, thrombosis, and dissection, although this would not be performed in the initial imaging evaluation. There is no relevant literature to support the use of arteriography in the initial evaluation of suspected acute invasive fungal sinusitis. CT Cone Beam Paranasal Sinuses CBCT is not helpful in the imaging assessment of patients with ARS with suspected orbital or intracranial complications because of the limited evaluation of the soft-tissue structures [19,25]. Sinonasal Disease CT Head CT head with IV contrast may be used to demonstrate intracranial complications but is less sensitive compared with MRI [6,23,43].
Sinonasal Disease. Affected patients are typically immunocompromised and include patients with neutropenia, hematologic malignancies, poorly controlled diabetes, acquired immunodeficiency syndrome, and organ transplantation and patients on immunosuppressive therapy including systemic steroids and chemotherapy [4,5]. Aspergillus and Mucoraceae species are seen in most cases. Presenting symptoms are nonspecific and include fever, rhinorrhea, and diplopia, similar to those seen with ABRS. Clinicians should maintain a high index of suspicion for this diagnosis in immunocompromised patients with symptoms of ARS, orbital symptoms, and/or headache. Nasal endoscopy may demonstrate pale mucosa progressing to ulceration and necrosis [4]. Definitive diagnosis is made on biopsy with the identification of invasive fungi in the sinonasal mucosa, vessels, and bone [4]. Given the angioinvasive nature of the fungi, complications include thrombosis, dissection, and pseudoaneurysm formation of the intracranial arteries, thrombosis of the cavernous sinus, infarction, and hemorrhage [4,6]. Treatment typically includes both systemic antifungal medication and surgical debridement. Arteriography Craniofacial Arteriography may be performed for further characterization and confirmation of vascular complications of invasive fungal sinusitis detected by MRI, MRA, or CTA, including pseudoaneurysm formation, thrombosis, and dissection, although this would not be performed in the initial imaging evaluation. There is no relevant literature to support the use of arteriography in the initial evaluation of suspected acute invasive fungal sinusitis. CT Cone Beam Paranasal Sinuses CBCT is not helpful in the imaging assessment of patients with ARS with suspected orbital or intracranial complications because of the limited evaluation of the soft-tissue structures [19,25]. Sinonasal Disease CT Head CT head with IV contrast may be used to demonstrate intracranial complications but is less sensitive compared with MRI [6,23,43].