Clinical Characteristics Other Than Intralesional Hyperdensity May Increase the Preoperative Diagnostic Accuracy of Maxillary Sinus Fungal Ball

Abstract

Objectives. This study aimed to evaluate the clinical characteristics of maxillary sinus fungus ball (MFB) to increase the preoperative diagnostic accuracy.Methods. A retrospective review of 247 patients who underwent endoscopic sinus surgery for unilateral maxillary sinusitis from January 2015 to December 2017 at a single institution was performed. Patients with pathologically proven MFB were compared to those with unilateral chronic maxillary sinusitis (CMS). Patient demographics and computed tomography (CT) findings were evaluated. The CT features were categorized as intralesional hyperdensity (calcification), the irregular lobulated protruding lesion (fuzzy appearance), maxillary sinus full haziness without mass effect, maxillary sinus full haziness with mass effect, and others. A regression tree analysis was performed.Results. In total, 247 patients were analyzed; among them, 179 (72.5%) had MFB and 68 (27.5%) had CMS. MFB showed predominance in older individuals. Among the radiological features, intralesional hyperdensity was most commonly associated with MFB. The presence of a fuzzy appearance or full opacity with mass effect was also associated with MFB. The highest area under the curve was noted with the regression tree analysis based on the model, which included the presence of intralesional hyperdensity, demographic data (age), and presence of fuzzy appearance or maxillary sinus full haziness with mass effect in case of absence of intralesional hyperdensity (0.904).Conclusion. A simple algorithm to optimize the preoperative diagnosis of MFB was developed. Physicians should be aware of such findings in the management of patients presenting with unilateral CMS.

Characteristic features of fungus ball in the maxillary sinus and the location of intralesional calcifications on computed tomographic images: A report of 2 cases

“…As metallic elements, zinc and calcium also contribute to micro-calcifications or spots with a metallic density on the CT image. 25 There are various ranges in prevalence rate of intrasinus calcification on CT scans in patients with fungus ball which has been reported to be 88%, 26 77%, 27 and on the other 50%-83% 28 . The sensitivity and specificity of CT imaging, using sinus opacification and the presence of areas with hyperattenuation as a diagnostic criterion for fungus ball, were reported to be 62% and 99%, respectively.…”

“…These features are compatible with the aforementioned mass effect. 28 It is not easy to distinguish sinonasal fungus ball from other forms of fungal or unilateral sinusitis based on radiologic findings alone, because the intralesional densities may also be found in AFRS and/or nonfungal maxillary sinusitis. 5 16 28 The location of the calcifications on sinus CT was also categorized as peripheral, central, or mixed pattern according to its location within the sinus CT scan.…”

“… 28 It is not easy to distinguish sinonasal fungus ball from other forms of fungal or unilateral sinusitis based on radiologic findings alone, because the intralesional densities may also be found in AFRS and/or nonfungal maxillary sinusitis. 5 16 28 The location of the calcifications on sinus CT was also categorized as peripheral, central, or mixed pattern according to its location within the sinus CT scan. 5 Most of the calcifications in fungal sinusitis were found to be centrally located within the maxillary sinus, while calcifications in nonfungal sinusitis were usually found at the periphery, near the wall of the maxillary sinus.…”

“…If intralesional calcification spots are not pres ent on CT images of the sinuses, it is difficult to diagnose fungus ball in the maxillary sinus preoperatively. 29 Cha et al 28 reported that the sensitivity of only one CT feature of intralesional hyperdensity in fungus ball was rather low (0.749), and there was a considerable risk of false negative results. They concluded that it is necessary to add clinical features of age and other radiographic features, such as full haziness with the mass effect, to increase the sensitivity of CT for the diagnosis of fungus ball in the maxi llary sinus.…”

Unveiling the Diverse Spectrum of Fungal Rhinosinusitis

“…Fungus balls are usually unilateral and located in the maxillary sinus. If intralesional hyperdensity (calcification) is observed on computed tomography, we can suspect the presence of fungus balls [5]. In addition, older age and specific lesion morphology (fuzzy or full) increase the diagnostic accuracy.…”