Abstract
Isolated sphenoid sinus lesions are an uncommon entity and present with non-specific symptoms. In this case report, the patient presented with a history of headaches for a duration of one month without sinonasal symptoms. A computed tomography scan showed a soft tissue mass occupying the sphenoid sinus. An endoscopic biopsy revealed fungal infection. Endoscopic wide sphenoidotomy with excision of the sphenoid sinus lesion was then performed however, the microbiological examination post-surgery did not show any fungal elements. Instead, Citrobacter species was implicated to be the cause of infection.
Highlights
Isolated sphenoid sinus lesions are a relatively uncommon entity and account for 1–2.7% of all paranasal sinuses lesions.[1]
Isolated sphenoid sinus lesions most commonly present with headache, followed by ophthalmological and nasal symptoms.[2]. High index of suspicion is required for early diagnosis as endoscopic nasal examinations can be normal despite the presence of a sphenoid sinus lesion.[2]. Delayed or improper management of sphenoid sinus lesions may lead to serious complications such as orbital abscess, cavernous sinus thrombosis, meningitis, and epidural, subdural, or cerebral abscesses.[3]. This case illustrates the complexity encountered in the management of such lesions
Inflammatory conditions appear to be the major cause of sphenoid sinus lesions accounting for 65-72% of cases, followed by neoplasm accounting for 16 – 17.5%.(2,4) Friedman et al[4] reviewed 50 patients with isolated sphenoid sinus lesions and 72% of the cases were due to inflammatory causes which included: chronic sinusitis 34%, fungal ball 20%, mucocele12%, acute sinusitis 4%, and chronic invasive fungal sinusitis 2%
Summary
Isolated sphenoid sinus lesions are a relatively uncommon entity and account for 1–2.7% of all paranasal sinuses lesions.[1]. The headache was retro-orbital extending to the occipital region She denied sinonasal symptoms such as nasal discharge, postnasal drip or nasal obstruction and there was no history of vomiting, blurred vision, or trauma to the head. A sphenoid sinus tumor was suspected and magnetic resonance imaging (MRI) was carried out. This revealed the same findings with those of the CT scan, with no obvious intracranial extension. Histopathological examination (HPE) of the biopsy specimen revealed colonies of fungi admixed with acute inflammatory cells. Repeat CT scan was performed three weeks post-operatively and a clear sphenoid sinus was seen (Figure 4). The patient was seen during followup and was symptom free, and nasal endoscopic examination showed clear sphenoid sinus with healthy mucosa
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