0:01

I have shown two fungus balls,

0:03

one in the sphenoid science, a little bit unusual,

0:06

and the other in the maxillary antrum.

0:08

Those are both examples of noninvasive fungal sinusitis.

0:13

You may recall that in the classification there was a second

0:16

form of non-invasive fungal sinusitis,

0:19

and that's called allergic fungal sinusitis.

0:23

Allergic fungal sinusitis is

0:25

as one would expect an allergic reaction to the

0:29

uh, pathogen.

0:31

That leads to PowerPoint formation.

0:34

It leads to multiple sinuses involved,

0:36

not just the single sinus the way we had with the,

0:40

uh, fungus ball.

0:41

And it often, uh, results in opacification

0:46

and expansion of the perinasal sinuses.

0:49

Let's look at an example of allergic fungal sinusitis.

0:53

Here in this example, we see

0:54

that we have the same hyperdense secretions,

0:58

but we noticed that the walls

0:59

of the maxillary antrum here have been eroded or expanded,

1:04

and some of the secretions

1:06

of hyperdensity are actually entering the nasal cavity.

1:09

You notice that the nasal cavity is also a pacified,

1:12

and this is involving bilateral maxillary antra as well

1:16

as the ethmoid sinuses.

1:17

Okay, we got sparing relatively of the frontal sinuses

1:22

and the sphenoid sinus.

1:24

Look at the expansion of this widen osteum

1:27

of the maxillary sinus that is typical of a

1:31

allergic fungal sinus size, which has a more

1:34

PowerPoint nature to it.

1:37

Well, the king of allergic fungal sinusitis,

1:42

in my opinion, is Siresh Mukerji.

1:46

Siresh Mukerjee wrote one

1:47

of the earliest papers on allergic fungal sinusitis

1:50

and the CT findings, this is back in 1998,

1:54

so 25 years ago, I guess.

1:57

Fortunately at the time that I was at the University

2:01

of Pennsylvania, CRESH included me in this paper,

2:04

and this is sort of the seminal paper

2:07

on allergic fungal sinusitis.

2:09

You see in the results here that multiple sinus involvement

2:14

occurred in 43 of the 45 patients.

2:17

There was increased attenuation in the sinus.

2:22

There was bilateral involvement more common than unilateral,

2:25

complete opacification, quite frequent as well.

2:29

Expansion of the involved sinus in 43 out

2:33

of the 45 patients and remodeling of the wall

2:37

or thinning of the bony walls as opposed to thickening

2:40

or erosion of the sinus wall was also present,

2:43

but it's not aggressive erosion

2:44

where it goes out into the adjacent soft tissues.

2:47

So let's look at a little, a few of his examples.

2:51

Again, note the hyper density note, the expansion

2:54

of the osteum that you can see.

2:56

It's polypoid in its appearance.

2:58

The nasal cavity is opacified as well.

3:02

Here you can see the thinning of the bone,

3:04

but it's not growing into the orbit.

3:07

It's not spreading to the orbit,

3:09

but maybe thinning it, sort of like a mucus seal does,

3:12

or as we would expect for polyps to do even thinning

3:16

of the lamina pap ratio In this example.

3:20

And here you can see again this expansion of the sinus,

3:24

but it's not aggressively invading the brain the way acute

3:29

invasive fungal sinus.

3:30

Sinus might. It's still confined by the periosteum.

3:34

So this is a, an article which most people do refer

3:37

to when they're regarding allergic fungal sinusitis by

3:42

my colleague here at ProScan in Cincinnati,

3:45

and certainly also a world renowned

3:48

head and neck radiologist.

3:50

ESMO Kaji.