C. Ekambar E. Reddy

Imaging of granulomatous and chronic invasive fungal sinusitis: comparison with allergic fungal sinusitis.

OBJECTIVE: To study the radiological features of chronic/granulomatous invasive fungal sinusitis (IFS) and identify differentiating characteristics, if any, from allergic fungal sinusitis (AFS). STUDY DESIGN: Prospective radiological study. SETTING: Tertiary hospital in northern India. SUBJECTS AND METHODS: Subjects were nonacute fungal sinusitis patients with orbital involvement presenting between January 1999 and December 2003. Seventeen IFS and 12 AFS patients with mean age 27 years (range 7-59 years) underwent computed tomographic scan (CT) and magnetic resonance imaging (MRI) of paranasal sinuses with contrast. These were operated within one month of doing the scans and had histologically confirmed fungal sinusitis. Outcome measures were characteristics of opacity produced by the diseased tissue on CT and MRI, side and number of sinuses involved, expansion of sinuses, areas of bone erosion, and extra-sinus extension. RESULTS: IFS showed homogenous opacity (isodense or hyperdense to muscle tissue) on CT and isointense and hypointense signal on T1- and T2-weighted MR images respectively. IFS showed involvement of one or two sinuses only, homogenous contrast enhancement, lack of expansion of sinuses, and bone erosion localized to the area of extra-sinus extension, and the extra-sinus component of the disease was more than the intra-sinus component. AFS showed heterogenous opacities with hyperattenuation areas on CT, isointense/hypointense to signal void on T1- and T2-weighted MR images. Expansion of sinuses, extensive bone erosion, lack of contrast enhancement, multiple sinus involvement, and major bulk of disease being intra-sinus rather than extra-sinus were other characteristics of AFS. CONCLUSION: Radiological features of IFS are described that are different from AFS.

Primary frontal sinus aspergillosis: an uncommon occurrence.

Primary frontal sinus aspergillosis is extremely uncommon with only few cases reported in the English literature. Isolated frontal sinus aspergillosis is usually asymptomatic and produces symptoms due to orbital or intracranial involvement. We report two cases of primary frontal sinus aspergillosis, presenting as frontoethmoidal mucocele and mimicking a ‘Potts puffy tumor,’ respectively. Forehead swelling produced by frontal sinus aspergillosis will be the first to be reported in the English literature.

Pigmented vagal paraganglioma

Paragangliomas are uncommon and those arising from the vagal trunk are rarer. Pigmented extra-adrenal paragangliomas are still rarer and reported sites of occurrence are the uterus, spine, retroperitoneum, bladder, mediastinum and orbit. The presence of abundant pigment in a cervical paraganglion has not been reported previously. We report one such unusual case of pigmented vagal paraganglioma that arose from the vagal trunk below the nodose ganglion, had massive central necrosis and showed hypovascularity on angiography. The unusual features and difficulties in the diagnosis of such cases are discussed.

Management of sharp esophageal foreign bodies in young children: a cause for worry.

The most common foreign bodies in children are coins, particularly in the age group of 2-5 years. Sharp esophageal foreign bodies in children are not commonly encountered. We present a report of two sharp foreign bodies in young children. Both of them required cervical esophagotomy for removal of the foreign body after an unsuccessful endoscopic attempt. The principles of evaluation and management of sharp and penetrating foreign bodies of the esophagus are described.