A pictorial review of imaging manifestations of rhino-orbito-cerebral mucormycosis–emerging threat in COVID pandemic

Abstract

Mucormycosis is an aggressive invasive fungal infection caused by mycocetes fungi. It is an opportunistic infection, associated with high morbidity and mortality. In the current era of COVID-19 pandemic, the entire world has witnessed a dramatic upsurge in cases of Mucormycosis. Paranasal sinuses are the commonest site to be affected with the tendency for rapid spread to orbit, face, and brain. Early diagnosis and prompt medical or surgical intervention are the only ways for preventing morbidity and saving precious lives. Imaging plays a crucial role not only in diagnosis but also in defining the extent of the disease for presurgical mapping. Black turbinate sign in the nasal cavity, mucosal thickening in paranasal sinuses with periantral invasion, and bony erosion are the early diagnostic signs. This pictorial review shall provide a comprehensive review of the various imaging manifestations of rhino-orbito-cerebral mucormycosis with a final proposed reporting checklist.

A Retrospective Study of Imaging of Invasive Rhino-Orbital-Cerebral Mucormycosis in the COVID-19 Pandemic in a Tertiary Care Center

“…In this study, the ethmoid sinus and maxillary were the most commonly involved sinuses. Unilateral involvement with the sinus involvement of multiple sinuses was more frequently noted by Aggarwal et al [9], and a similar trend was noted in our study. Sinonasal involvement is seen on CT scans as a mucosal thickening or opacification of involved sinuses, which may be hyperdense due to heavy metal content in fungal hyphae and show heterogeneous or peripheral enhancement.…”

“…Moreover, 8.33% of cases presented with a fungal abscess, which showed restriction on the diffusion-weighted study and peripheral rim enhancement on the postcontrast MRI. Leptomeningeal enhancement was seen in advanced disease by Aggarwal et al [9], a similar finding noted in the present study in 6.25% of cases. The pathobiology of mucormycosis is characterized by the proliferation of angioinvasive hyphae within the elastic lamina of large to intermediate-sized arteries, which necessitates a meticulous evaluation of the intracranial and facial vasculature [4].…”