title: Paranasal sinuses computed tomography in the initial evaluation of patients with suspected invasive fungal rhinosinusitis.
abstract: Invasive fungal rhinosinusitis (IFR) is a complication that presents mainly in immunocompromised patients. Paranasal sinuses computed tomography (PCT) is frequently obtained during initial evaluation of suspected cases. The objective of the study was to determine the imaging findings that suggest IFR in patients with hematological malignancies. In the retrospective case/control study, we included 14 patients with hematological malignancies that developed IFR in the Hospital Clínico de la Pontificia Universidad Católica de Chile between January 2005 and June 2009. Twenty patients with hematological malignancies, with suspected sinonasal infectious involvement requiring a PCT for initial evaluation, were chosen as the control group. Thirteen imaging parameters were compared between both groups. Osseous erosion and facial soft tissue thickening were statistically associated with the presence of IFR (p < 0.05). The presence of osseous erosion, facial soft tissue thickening, extrasinus extension or unilateral involvement had a positive predictive value of 100%, with an incidence among the total group of 12, 15, 9 and 9%, respectively. No patients with IFR had a normal PCT. Most PCTs in the initial evaluation of suspected IFR had nonspecific findings. The clinician must have a high index of suspicion and complement the workup with other diagnostic techniques to initiate appropriate treatment.
authors.affiliation: Department of Otolaryngology, Hospital Clínico de la Pontificia Universidad Católica de Chile, Santiago, Chile. andresfk@gmail.com.
authors.forename: Andrés
authors.initials: A
authors.lastname: Finkelstein
authors.affiliation: Department of Otolaryngology, Hospital Clínico de la Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Daniela
authors.initials: D
authors.lastname: Contreras
authors.affiliation: Department of Otolaryngology, Hospital Clínico de la Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Javiera
authors.initials: J
authors.lastname: Pardo
authors.affiliation: Department of Radiology, Hospital Clínico de la Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Cruz
authors.affiliation: Department of Otolaryngology, Hospital Clínico de la Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Claudia
authors.initials: C
authors.lastname: Gonzalez
authors.affiliation: Department of Otolaryngology, Hospital Clínico de la Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: M
authors.initials: M
authors.lastname: Constanza Beltrán
authors.affiliation: Department of Otolaryngology, Hospital Clínico de la Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Ximena
authors.initials: X
authors.lastname: Fonseca
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000000981:diagnostic imaging*; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging* / Q000382:microbiology; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000382:microbiology; D012852:Sinusitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000382:microbiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult