Allergic Fungal Sinusitis: Slideshow

A 9-year-old girl with allergic fungal sinusitis displaying telecanthus and asymmetric positioning of her eyes and globes.

Coronal computed tomographic (CT) scan of the patient in slide 1 showing typical unilateral appearance of allergic fungal sinusitis with hyperintense areas and inhomogeneity of the sinus opacification; the hyperintense areas appear whitish in the center of the allergic mucin.

A 15-year-old boy with allergic fungal sinusitis causing right proptosis, telecanthus, and malar flattening; the position of his eyes is asymmetric, and his nasal ala on the right is pushed inferiorly compared with the left.

Coronal CT scan of the patient in slide 3, showing extensive allergic fungal sinusitis involving the right side with mucocele above the right orbit and expansion of the sinuses on the right.

Coronal magnetic resonance imaging (MRI) of the patient in slide 3, showing expansion of the sinuses with allergic mucin and polypoid disease; the hypointense black areas in the nasal cavities are the actual fungal elements and debris. The density above the right eye is the mucocele. The fungal elements and allergic mucin in allergic fungal sinusitis always look hypointense on MRI scanning and can be mistaken for absence of disease.

View just inside the nasal vestibule of the patient seen in slide 3, showing diffused polyposis extending into the anterior nasal cavity and vestibule; the septum is on the right, and the right lateral vestibular wall (nasal ala) is on the left. The polyps are in the center. The polyps almost hang out of the nasal vestibule.

Fungal ball in the right maxillary sinus.

Fungal debris being removed from the ethmoid complex. A suction device is seen in the right lower corner of the image.

Left middle meatus with suctioning of thick allergic mucin from the ethmoid bulla in the center of the image; the end of the suction is in the inferior portion of the image.

The viscosity of a thick allergic mucin is being suctioned from the nasal cavity and vestibule in a patient with allergic fungal sinusitis.

Allergic mucin, fungal debris, and polyps are shown after removal from the patient. The scale is in inches.

Immediate postoperative 30° angle view of the patient in slide 3 showing the complete removal of polyps with a widened frontal sinus recess superiorly and widened ethmoid cavity in the midportion. The middle turbinate is on the right, pushed against the septum. The lateral nasal wall is on the left.

Typical view of a middle meatus in a patient with allergic fungal sinusitis with expansion of the ethmoid complex and extension of the middle turbinate more inferiorly. This is a postoperative view.

Coronal CT scan showing the postoperative view of the patient in slide 3 following removal of disease after significant disease recurred on both the right and left sides of the nasal cavity and sinuses; mild mucosal thickening of all involved sinuses is present, with some moderate thickening of the left maxillary sinus. All disease, even the lateral mucocele, was removed or drained endoscopically.

Two-week postoperative endoscopic picture of the same endoscopic view as slide 12 of the patient in slide 3, showing polypoid thickening already in the ethmoid cavities while the patient was still on tapering steroids; on the left is the lateral nasal wall. The right shows the middle turbinate next to the septum.

A polypoid recurrence in the center of the ethmoid cavity. The septum is on the left.

For more information, see the following resources:

• eMedicine, Otolaryngology and Facial Plastic Surgery: Allergic Fungal Sinusitis
• eMedicine, Otolaryngology and Facial Plastic Surgery: Sinusitis, Fungal
• eMedicine, Otolaryngology and Facial Plastic Surgery: Sinusitis, Acute, Medical Treatment
• eMedicine, Infectious Diseases: Sinusitis, Acute
• eMedicine, Emergency Medicine: Sinusitis

Contributor Information

Medical Reviewer
John E. McClay, MD
Associate Professor of Pediatric Otolaryngology
Department of Otolaryngology-Head and Neck Surgery
Children's Hospital of Dallas
University of Texas Southwestern Medical School
Dallas, Texas

John E. McClay, MD, has disclosed no relevant financial relationships.

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