Fungal ball (FB) sinusitis, also referred to as mycetoma or aspergilloma, is a chronic non-invasive mycotic disease. This study aimed at analysing the natural history and outcomes of patients with incidental paranasal FB on imaging. This was a retrospective study of patients who underwent imaging (CT/MRI/PET) of the head for any indication with incidental paranasal FB, during 2012–2023. Features on CT: intrasinus calcification and partial/complete opacification; sinus bony wall sclerosis/erosion. Features on MRI: hyperintensity on T1 and iso-intensity on T2-weighted images. Eighty-three patients (of 108,369 screened imaging studies) had findings of sinus FB, giving a 0.075% incidental rate of FB. Of these, 44 (53%) were females and 39 (47%) males, mean age 78. Most concomitant disease was hypertension followed by diabetes and immunosuppressive medications. Most involved sinuses were maxillary (50.6%) followed by sphenoid (43.4%), and 97.6% had unilateral FB. By the end of follow-up (median follow-up time 59.2 months), 5 patients (6%) underwent FESS to treat the involved sinus, indications being unilateral headache/pain (2 patients) accompanied by nasal blockage and rhinorrhoea (1 patient); nasal blockage and rhinorrhoea (1 patient); and incidental finding in 1 patient who had urgent FESS for epistaxis. The remaining 78 (94%) of patients with incidental FB did not receive any treatment, without morbidity or complications. Forty-nine patients had 2 consecutive scans with a minimum of 6 months interval. When comparing the first and last scan, there was no change in 59.2%; worsening opacification within the sinus in 26.5%; worsening opacification out of the sinus in 4.1%; and improvement in 10.2%. No differences between the interval scans were found with regards to other radiological characteristics. Most patients with incidental FB are asymptomatic without disease-specific morbidity. The authors conclude that surgical intervention for asymptomatic paranasal FB in elderly comorbid patients, who may be at risk for general anaesthesia, is not a must. Clinical and imaging follow-up is a reasonable alternative, with special attention to sphenoid fungal balls (given the important critical adjacent structures) for worsening symptoms or imaging findings. Further studies on younger patients with longer follow-up duration is warranted.
Incidental paranasal sinus fungal balls
Reviewed by Richard (Wei Chern) Gan
Natural history of incidental paranasal sinus fungal balls: evidence from a decade-long imaging-based cohort.
CONTRIBUTOR
Richard (Wei Chern) Gan
Hull University Teaching Hospitals NHS Trust, UK.
View Full Profile
