0:00

As opposed to the previous PowerPoint case

0:03

where I showed hyperdensity centrally within

0:07

a sinus in multiple sinuses, this patient had

0:11

hyperdensity exclusive to the right sphenoid sinus.

0:15

Now, it does have some of the same features

0:18

that I described previously in that case with

0:21

the maxillary sinus, and that is that we see

0:24

that the wall of the sphenoid sinus is thickened

0:27

on the left side compared to the right side.

0:30

We see on the bone window the

0:32

internal calcifications here,

0:34

or hyperdensity within the secretion.

0:37

We note that there's just a little bit

0:39

of mucosal thickening right at the spheno-

0:41

ethmoidal recess on this individual.

0:44

And then on the soft tissue

0:47

windows, we could see those

0:49

areas of hyperdensity within the sinus

0:52

even more clearly. This patient had chronic

0:55

headaches, and it was determined that this

0:58

could be the source of the patient's headaches.

1:00

So this was removed endoscopically,

1:03

and this was a fungus ball.

1:06

So a fungus ball usually localized to a single sinus

1:10

with hyperdense secretions, usually with evidence of

1:13

chronic sinusitis. Hyperdense in the paranasal sinus.

1:18

Let's just look on the coronal images with

1:20

a bone window and see whether we have any

1:24

anatomic variants that are important here.

1:27

So here is our chronic osteitis wall,

1:32

thickening, the hyperdensity to the sinus.

1:35

Here's the sphenoethmoidal recess

1:37

obstruction, normal on the other side.

1:42

I guess this otherwise looks pretty good.

1:44

So an example of a patient with an unusual

1:48

location, sphenoid sinus fungus ball.