What is the role of imaging studies in the workup of mold- related allergic fungal sinusitis (AFS)?

Updated: Dec 02, 2020
  • Author: Shih-Wen Huang, MD; Chief Editor: Harumi Jyonouchi, MD  more...
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CT scanning of the paranasal sinuses may reveal a persistently opacified sinus cavity despite prolonged antibiotic therapy. AFS commonly causes unilateral sinus opacification due to obstruction of the sinus ostium with thick, inspissated mucus. CT scanning should reveal a persistently opacified sinus cavity that may be expansile. CT scanning may also reveal high attenuation in the opacified sinus due to high protein concentration. In a series of 6 children with a diagnosis of allergic Aspergillus sinusitis, all 6 had CT findings of diffuse expansile sinus disease, and 4 had evidence of bony erosion, which raised the suspicion for malignancy.

Corresponding lesions have a characteristic hypointense appearance on T1-weighted and T2-weighted images on sinus MRIs. Such lesions are nearly pathognomic for AFS, but they are not always present.

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