Findings
- T2 isointense to hypointense signal material in left ethmoid air cells extending into the olfactory recess as well as along the left superior and middle nasal turbinates with nonenhancement of the left middle turbinate
- This material appears to extend across the cribriform plate and along the floor of the left anterior cranial fossa with adjacent patchy T2 hyperintensity and enhancement in the left gyrus rectus
- Abnormal enhancement in the left pterygopalatine fossa
- Infiltrative enhancement in the intraconal and extraconal left orbit with an enlarged, T2 hyperintense left medial rectus muscle and abnormal circumferential enhancement of the left optic nerve sheath
- Left proptosis
- Engorged left superior ophthalmic vein which appears nonenhancing near the orbital apex with mild bulging of the lateral wall of the left cavernous sinus
- T1 signal hyperintensity in the bilateral globi pallidi
Diagnosis
Invasive fungal sinusitis
Sample Report
Findings are highly concerning for invasive fungal sinusitis spreading from left ethmoid air cells superiorly along the floor of the left anterior cranial fossa, laterally into the left orbit, and posteriorly into the left pterygopalatine fossa. Associated necrosis of the left middle turbinate, left medial rectus myositis, left optic perineuritis, left proptosis, and inferior left frontal cerebritis. No evidence of intracranial abscess. Recommend urgent ENT and neurosurgical evaluation.
Additionally, there are findings concerning for early left superior ophthalmic vein and left cavernous sinus thrombosis.
T1 signal hyperintensity in the bilateral globi pallidi, which is nonspecific but can be seen in the setting of hepatic failure.
Discussion