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Chronic invasive sinus aspergillosis Pt DA 68yr male. View full case history

right

A MRI (T2-weighted, transversal view).Note oedema of the right temporal lobe.
MRI brain scan

B MRI (T1-weighted, transversal view). The blue pointer shows progression of inflammatory tissue into the brain. The green pointer shows involvement of the lateral group of external ocular muscles.
CT sinuses

C CT scan image (bone window, coronal view) demonstrating destruction of the inferior wall of the right orbit.
MRI brain

D MRI (T1-weighted, contrast-enhanced, transversal view). The pointers show abnormal enhancement in the right orbit (green), in the right temporal lobe (blue) and of the dura (yellow).
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MRI brain scan

E MRI (T1-weighted, contrast-enhanced, coronal view). The pointers show pathological tissue in the right cavernous sinus (blue) and pathological enhancement of the right optical nerve (green).
MRI scan

F MRI (T1-weighted, contrast-enhanced, sagittal view). The pointers show pathological tissue in the right orbit (blue) with protrusion into the right optical canal (green).

This 68 year man with a history of hypertension and ischemic heart disease presented with nasal obstruction, localised swelling and pain in his right cheek for about two months. CT scan showed a soft tissue mass filling the right maxillary sinus adjacent to the floor of the orbit. Maxillotomy with mass removal was performed and culture grew A. fumigatus. Histology was not performed and the patient received no antifungal therapy. 5 months later localised relapse with progression along the medial wall of the orbit was seen on CT scan.

 

Images provided by Dr Daša Cerar1, Dr Tatjana Lejko-Zupanc1, Dr Katarina Šurlan-Popovič2, and Dr Zmago Novak3

1 University Medical Centre Ljubljana, Department of Infectious Diseases, Japljeva 2, Ljubljana, Slovenia
2 University Medical Centre Ljubljana, Department of Radiology
3 University Medical Centre Maribor, Department of Infectious Diseases, Maribo


 

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