MRI as a road map for surgical intervention of acute invasive fungal sinusitis in Covid‐19 era

Sweed, Ahmed Hassan; Mobashir, Mohamed; Elnashar, Ismail; Anany, Ahmed; Elmaghawry, Mohammed Elsayed; Ibrahim, Enas Moustafa; Eesa, Mohamed

doi:10.1111/coa.13907

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…MRI had a great role in assessment periantral area, so any hyperintense signal in T1+contrast was denoting venous congestion around pathology, hyperintense signal in T2 fat suppression was denoting inflammatory reaction. These areas had to be explored surgically to achieve effective debridement till reaching healthy vascular margins [7] .…”

Section: Discussionmentioning

confidence: 99%

Septal Necrosis as Primary Presentation for Mucormycosis in Covid-19 Era

Sweed

mobashir²,

Elsheikh³

et al. 2022

Egyptian Journal of Ear, Nose, Throat and Allied Sciences

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Objectives: To report unusual presentation of sinonasal mucormycosis, To emphasize on importance of MRI sequences in dealing with mucormycosis cases. Patients and Methods: We reported a case with persistent rhinological symptoms after Covid-19 recovery, presented endoscopically with necrotic eschar/crust on nasal septum with apparently normal lateral nasal mucosa. MRI T2 fat suppression revealed inflammatory process within RT pterygopalatine / infratemporal fossa territory. Endoscopic sinus surgery was done for debridement of necrotic septal nasal mucosa, exploration of RT PPF / ITF shows pus emerging from it with necrosis of posterior feeding vessel of the nose "SPA". Nasal septum is characterized by double vascularity from both side , but sudden interruption from one side could not be compensated from healthy side leading to necrosis. Conclusion: Any persistent rhinological symptoms after covid-19 infection with necrotic eschar anywhere within rhinoorbital territory should be considered as mucormycosis till prove otherwise.

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Section: Discussionmentioning

confidence: 99%

Septal Necrosis as Primary Presentation for Mucormycosis in Covid-19 Era

Sweed

mobashir²,

Elsheikh³

et al. 2022

Egyptian Journal of Ear, Nose, Throat and Allied Sciences

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“…Few studies have described imaging features of COVID-19associated AIFR. 10,[13][14][15][16][17][18][19] We have described imaging findings in 90 studies including computed tomography (CT) and magnetic resonance imaging (MRI) of 60 patients of post-COVID-19 AIFR admitted and managed at our institute.…”

Section: Introductionmentioning

confidence: 99%

Imaging Features of COVID-19-Associated Acute Invasive Fungal Rhinosinusitis

Yadav

Kumar

Sachdeva

et al. 2023

Indian Journal of Neurosurgery

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Background Acute invasive fungal rhinosinusitis (AIFR) is a rare, rapidly progressive, and life-threatening infection involving the nasal cavity and paranasal sinuses. Purpose of this study is to describe imaging features of coronavirus disease-2019 (COVID-19)-associated AIFR. Methods This was a retrospective observational study. Inclusion criteria: (1) post-COVID-19 patients with fungal rhinosinusitis detected on potassium hydroxide smear or histopathology; (2) onset of symptoms (facial pain, dental pain, facial swelling or discoloration, nasal bleed, periorbital swelling, ptosis, redness of eyes, vision loss) less than 4 weeks; and (3) magnetic resonance imaging/computed tomography (MRI/CT) done within 5 days before surgery. Exclusion criteria: (1) cases of sinusitis without a history of previous COVID-19 infection; and (2) cases in whom fungal hyphae were not demonstrated on pathological examination. Noncontrast CT and dedicated MRI sequences were done initially. Site of involvement, unilateral/bilateral involvement, pattern of mucosal thickening, enhancement pattern, periantral invasion, orbital invasion, intracranial involvement, perineural spread, vascular involvement, and bony involvement were recorded. CT and MRI imaging features were compared. Results Analysis of 90 studies (CT and MRI) in 60 patients was done. Most common site of involvement was ethmoid followed by maxillary sinus. Bilateral disease was more common. Mucosal thickening with T2 hypointense septations was seen in 88.4% MRI studies. Periantral and orbital involvement was seen, respectively, in 84.6% and 55.7% cases of MRI. Intracranial involvement was noted in form of meningitis, cerebritis, abscess, infarct, hemorrhage, cavernous sinus, or perineural invasion. Vascular involvement was noted in form of vascular occlusion (n = 3), vascular narrowing (n = 3), and pseudoaneurysm (n = 2). MRI was more sensitive in detecting periantral invasion, deep infratemporal fossa, cavernous sinus involvement, perineural invasion, optic nerve involvement, and vascular occlusion and narrowing, while CT was superior in identification of bony erosions. Conclusion Early recognition of AIFR in post-COVID-19 patients is important to prevent disease-related morbidity/mortality. Several rarely described findings are noted in our series of AIFR, like optic nerve involvement, pituitary fungal abscess, perineural spread, fungal aneurysms, and arteritis-related posterior circulation infarcts. MRI is superior for early detection of disease and in estimation of extent of disease, compared with CT. Imaging can help in early detection of AIFR, which has a significant impact on patient outcome.

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