Fungal sinusitis can be invasive and noninvasive and has 5 subtypes. Invasive subtypes include acute invasive fungal sinusitis, chronic invasive fungal sinusitis, and chronic granulomatous invasive fungal sinusitis; noninvasive subtypes include allergic fungal sinusitis and fungus ball (fungal mycetoma). The treatment strategies for the subtypes are different, as are their prognoses [35]. Acute invasive fungal sinusitis is the most lethal subtype with mortality rates reaching 50% to 80%; therefore, a high level of clinical suspicion is critical [36]. It is typically seen in immunocompromised children, often times with hematological malignancies with low neutrophil counts. Painless nasal septal necrosis is the classical clinical presentation [34,35,37]. Allergic fungal sinusitis occurs in atopic children with refractory sinus disease, which requires a high index of suspicion for evaluation and aggressive treatment [38]. Allergic fungal sinusitis is more aggressive in children with increased fungal load and higher incidence of proptosis when compared with adults [39]. Allergic fungal sinusitis in children is also less responsive to treatment with increased recurrence rates [40]. Discussion of Procedures by Variant Variant 1: Child. Uncomplicated acute sinusitis. Initial imaging. CT Paranasal Sinuses CT of the paranasal sinuses without or with contrast is not recommended in children as the diagnosis of uncomplicated acute sinusitis is based on clinical criteria alone. MRI Paranasal Sinuses MRI of paranasal sinuses without or with intravenous (IV) contrast is not recommended in children, as the diagnosis of uncomplicated acute sinusitis is based on clinical criteria alone. Radiography Paranasal Sinuses Radiographs are not recommended in uncomplicated acute sinusitis in children as the diagnosis of uncomplicated acute sinusitis is based on clinical criteria alone. Variant 2: Child.
Sinusitis Child. Fungal sinusitis can be invasive and noninvasive and has 5 subtypes. Invasive subtypes include acute invasive fungal sinusitis, chronic invasive fungal sinusitis, and chronic granulomatous invasive fungal sinusitis; noninvasive subtypes include allergic fungal sinusitis and fungus ball (fungal mycetoma). The treatment strategies for the subtypes are different, as are their prognoses [35]. Acute invasive fungal sinusitis is the most lethal subtype with mortality rates reaching 50% to 80%; therefore, a high level of clinical suspicion is critical [36]. It is typically seen in immunocompromised children, often times with hematological malignancies with low neutrophil counts. Painless nasal septal necrosis is the classical clinical presentation [34,35,37]. Allergic fungal sinusitis occurs in atopic children with refractory sinus disease, which requires a high index of suspicion for evaluation and aggressive treatment [38]. Allergic fungal sinusitis is more aggressive in children with increased fungal load and higher incidence of proptosis when compared with adults [39]. Allergic fungal sinusitis in children is also less responsive to treatment with increased recurrence rates [40]. Discussion of Procedures by Variant Variant 1: Child. Uncomplicated acute sinusitis. Initial imaging. CT Paranasal Sinuses CT of the paranasal sinuses without or with contrast is not recommended in children as the diagnosis of uncomplicated acute sinusitis is based on clinical criteria alone. MRI Paranasal Sinuses MRI of paranasal sinuses without or with intravenous (IV) contrast is not recommended in children, as the diagnosis of uncomplicated acute sinusitis is based on clinical criteria alone. Radiography Paranasal Sinuses Radiographs are not recommended in uncomplicated acute sinusitis in children as the diagnosis of uncomplicated acute sinusitis is based on clinical criteria alone. Variant 2: Child.