0:00

This is another example of a path-proven fungus ball.

0:04

On the bone window, we see that the patient has

0:09

no pacification of the left maxillary antrum,

0:11

with areas of contents that almost mimic

0:15

that of the bone. On the soft tissue window,

0:19

we're a little bit more

0:19

convinced of how dense this is.

0:21

You notice that it's centrally located

0:24

within the perinasal sinus, and in

0:26

this case, it was indeed a fungus ball.

0:28

How do we know that this is

0:29

not, for example, an osteoma?

0:32

Well, osteomas usually would not

0:34

be central within the sinus.

0:36

They usually come off of a bony wall.

0:38

We also noticed that in this case, as with

0:41

the previous case, there is chronic osteitis with

0:43

thickening of the bone wall, which suggests

0:45

that this is a chronic inflammatory process.

0:48

How do we know that this is not a chondroid lesion?

0:51

Well, there really isn't any cartilage within

0:54

the central aspect of the perinasal sinus.

0:57

Most of the chondroid lesions will be

0:59

coming off of the nasal septum or other

1:01

structures, so that would not make sense that

1:04

something that was central within the sinus—

1:07

How do we know that this isn't just

1:08

chronic hyper-proteinaceous secretions?

1:10

After all, the patient does

1:12

show evidence of chronic osteitis.

1:14

The popcorn-like nature to this calcification

1:18

is unusual for chronic sinusitis,

1:21

with hyper-proteinaceous secretions, where

1:23

it's usually more uniform in its density.

1:26

This has a focal area where it's

1:29

obviously much, much more dense.

1:31

How do we know that this is not melanoma?

1:33

Again, melanoma doesn't calcify.

1:35

It may be hyperdense, but it's not as dense as

1:38

the bone, as you can see here in this fungus ball.

1:42

So, for these various reasons,

1:44

we would suggest that this is a fungus ball.

1:46

It's not hemorrhage because of this, again,

1:49

irregular cluster of the hyperdensity,

1:52

that would be unusual for hemorrhage.