E2397. The Many Faces of Invasive Fungal Rhinosinusitis
  1. Brian Yep; University of California, Irvine
  2. Eleanor Chu; University of California, Irvine
  3. Jennifer Soun; University of California, Irvine
  4. David Floriolli; University of California, Irvine
  5. Charles Li; University of California, Irvine
  6. Edward Kuan; University of California, Irvine
  7. Edward Kuoy; University of California, Irvine
There are two major subtypes of invasive fungal rhinosinusitis (IFS), acute (AIFS), and chronic (CIFS). AIFS is a rapidly progressive infectious process characterized by tissue and vascular invasion, with associated high mortality. It is a disease process that afflicts the immunocompromised, with predominantly Zygomycetes species affecting diabetic patients and Aspergillus species affecting severe neutropenic patients. There should be a high suspicion for AIFS when an immunocompromised patient presents with concerning clinical symptoms including vision changes, diplopia, proptosis, or cranial neuropathy. CIFS, on the other hand, has a more prolonged course and may not afflict immunocompromised patients.

Educational Goals / Teaching Points
There are a variety of etiologies for rhinosinusitis, with IFS being one of the more alarming subtypes. AIFS is a fulminant process where early detection and treatment can improve outcomes. Thus, it is essential to recognize appropriate clinical scenarios and key imaging findings that would be suggestive of AIFS. CIFS is an important entity to be aware of that can present with clinically alarming symptoms depending on sites of involvement, and one can assist in this diagnosis by recognizing the potential imaging findings.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Computed tomography (CT) and magnetic resonance imaging (MRI) are the most common modalities to evaluate for IFS. IFS can present in a variety of fashions that will be reviewed in this presentation. We will highlight common anatomic areas of involvement that should raise concern for IFS, such as the peri-antral fat, pterygopalatine fossa, nasal cavity, and lacrimal canal region. We will present different cases to reinforce the important imaging features, from classic rhinosinusitis features, aggressive orbital and intracranial extension, fulminant retrograde perineural spread, and cases that largely spare the sinonasal cavities.

It is important for radiologists to be aware of the clinical scenarios and concerning imaging features that should heighten the concern for invasive fungal sinusitis.