QUIZ: No. 5, Mar 30 , 2025

Case 5 (30/03/2025): A 47-year-old male presented with complaints of rhinorrhoea and head-ache. No significant medical and surgical history. CT and CE-MRI images are provided. What’s your diagnosis?

                                                                                                                   MRI 

MRI 

                                                                                                                                               CT 

A 47-year-old male presented with complaints of rhinorrhoea and head-ache. No significant medical and surgical history. CT and CE-MRI images are provided. What’s your diagnosis?

ANS – Invasive fungal sinusitis (Rhino-orbital mucormycosis)

Findings: Heterogeneously enhancing T2 heterogeneously hyperintense and T1 iso-hypointense soft tissue thickening seen in the left nasal cavity and posterior ethmoid sinus. There is thin enhancing extra-conal soft tissue thickening in the infero-medial aspect and floor of left orbit. No bony destruction.

Sinonasal mucormycosis is an uncommon form of invasive fungal sinus infection and it can involve orbits and/or intracranial structures.

Mucormycosis is a fulminant, locally aggressive fungal infection of paranasal sinuses with variable extension into orbits.

Take home points

Infection may spread intraorbitally through small osseous vascular channels without frank bony destruction.

P.S – Sample taken from left nasal cavity showed Rhizopus sp growth in culture.