Lesion In Nasal Cavity Research Articles

Diagnostic accuracy of clinical visual assessment using endoscopic images for nasal cavity mass lesions.

Objectives: Discrimination of nasal cavity lesions using nasal endoscopy is challenging because of the differences in clinical manifestations and treatment strategies. We aimed to investigate the diagnostic accuracy of clinical visual assessment (CVA) of nasal cavity masses using endoscopic images and determine whether there is a difference according to pathologic class and the examiners' experience. Methods: We collected pathologically confirmed endoscopic images of normal findings, nasal polyp (NP), benign tumor, and malignant tumor (each class contained 100 images) randomly selected. Eighteen otolaryngologists, including six junior residents, six senior residents, and six board-certified rhinologists classified the test set images into four classes of lesions by CVA. Diagnostic performance according to the pathologic class and the examiner's experience level was evaluated based on overall accuracy, F1-score, confusion matrix, and area under the receiver operating characteristic curve (AUC). Results: Diagnostic performance was significantly different according to the pathological class of nasal cavity mass lesions with the overall accuracy reported high in the order of normal, NP, benign tumor, and malignant tumor (0.926 ± 0.100; 0.819 ± 0.135; 0.580 ± 0.112; 0.478 ± 0.187, respectively), F1 score (0.937 ± 0.076; 0.730 ± 0.093; 0.549 ± 0.080; 0.554 ± 0.146, respectively) and AUC value (0.96 ± 0.06; 0.84 ± 0.07; 0.70 ± 0.05; 0.71 ± 0.08, respectively). The expert rhinologist group achieved higher overall accuracy than the resident group (0.756 ± 0.157 vs. 0.680 ± 0.239, p < .05). Conclusion: CVA for nasal cavity mass was highly dependent on the pathologic class and examiner's experience. The overall accuracy was reliably high for normal findings, but low in classifying benign and malignant tumors. Differential diagnosis of lesions solely based on nasal endoscopic evaluation is challenging. Therefore, clinicians should consider further clinical evaluation for suspicious cases.

Deep learning algorithm for the automated detection and classification of nasal cavity mass in nasal endoscopic images.

Nasal endoscopy is routinely performed to distinguish the pathological types of masses. There is a lack of studies on deep learning algorithms for discriminating a wide range of endoscopic nasal cavity mass lesions. Therefore, we aimed to develop an endoscopic-examination-based deep learning model to detect and classify nasal cavity mass lesions, including nasal polyps (NPs), benign tumors, and malignant tumors. The clinical feasibility of the model was evaluated by comparing the results to those of manual assessment. Biopsy-confirmed nasal endoscopic images were obtained from 17 hospitals in South Korea. Here, 400 images were used for the test set. The training and validation datasets consisted of 149,043 normal nasal cavity, 311,043 NP, 9,271 benign tumor, and 5,323 malignant tumor lesion images. The proposed Xception architecture achieved an overall accuracy of 0.792 with the following class accuracies on the test set: normal = 0.978 ± 0.016, NP = 0.790 ± 0.016, benign = 0.708 ± 0.100, and malignant = 0.698 ± 0.116. With an average area under the receiver operating characteristic curve (AUC) of 0.947, the AUC values and F1 score were highest in the order of normal, NP, malignant tumor, and benign tumor classes. The classification performances of the proposed model were comparable with those of manual assessment in the normal and NP classes. The proposed model outperformed manual assessment in the benign and malignant tumor classes (sensitivities of 0.708 ± 0.100 vs. 0.549 ± 0.172, 0.698 ± 0.116 vs. 0.518 ± 0.153, respectively). In urgent (malignant) versus nonurgent binary predictions, the deep learning model achieved superior diagnostic accuracy. The developed model based on endoscopic images achieved satisfactory performance in classifying four classes of nasal cavity mass lesions, namely normal, NP, benign tumor, and malignant tumor. The developed model can therefore be used to screen nasal cavity lesions accurately and rapidly.

МУЛЬТИМОДАЛЬНАЯ ВИЗУАЛИЗАЦИЯ ОСЛОЖНЕНИЙ ЧЕЛЮСТНО-ЛИЦЕВОЙ ОБЛАСТИ У ПАЦИЕНТОВ С САХАРНЫМ ДИАБЕТОМ, ПЕРЕНЕСШИХ COVID-19

Abstract. Introduction. COVID-19 is widely known as a disease that causes respiratory dysfunction. However, it is also associated with many extrapulmonary manifestations and complications, such as gastrointestinal and hepatocellular complications, neurological diseases, and maxillofacial complications. Aim of this study was to describe the MSCT and MRI findings in 56 patients with COVID-19-associated rhino-orbital mucormycosis. Materials and Methods. CT and/ or MRI imaging was performed on 56 patients with diabetes mellitus who recovered after having been diagnosed with COVID-19 and had maxillofacial complications. Results and Discussion. All patients had sinusitis and ophthalmic symptoms. In all patients, there were the sequential anatomical lesions of nasal cavity, maxillary sinus, orbits, and lattice cells. Conclusions. Computer tomography or magnetic resonance imaging can be used to evaluate the spread of rhino-orbital mucormycosis to detect bone destruction, infiltration, and tissue invasion. Computer tomography of paranasal sinuses is the method of choice at suspicion on mycotic infections, such as rhino-orbital mucormycosis. It is recommended to perform magnetic resonance tomography of soft tissues at suspicion on mycotic invasion beyond paranasal sinuses.

CLINICOPATHOLOGICAL STUDY OF NON-NEOPLASTIC LESIONS OF NASAL CAVITY AND PARANASAL SINUSES IN A TERTIARY CARE TEACHING HOSPITAL

Objective: A variety of non-neoplastic lesions involving the nasal cavity (NC) and paranasal sinuses (PNS) are encountered in clinical practice. The clinical features, symptoms, and advanced imaging technique help to reach a provisional diagnosis but histopathological examination remains the mainstay of final definitive diagnosis. There is a lack of studies that exclusively cover non-neoplastic lesions of sinonasal region. Hence, this study was done with the aim of examining the clinicopathological features of various non-neoplastic lesions of NC and PNS. Methods: The formalin-fixed specimens of polypectomy/biopsy were received with complete clinical and radiological features in the department of pathology. Routine gross examination and required number of sections were taken and stained with hematoxylin and eosin stain. Periodic acid Schiff’s was used wherever necessary. Results: Histologically, maximum number of cases were of inflammatory polyp (IP) (57%), followed by Allergic polyp (AP) (18%) and Invasive Fungal Sinusitis-Mucormycosis (17%). Mucormycosis was found in patients who have recovered from COVID along with a steroid intake history or had diabetes mellitus or had multiple comorbidities along with COVID recovery and steroid intake. Conclusion: Among the non-neoplastic lesion, IP is the most common lesion followed by AP. The significant number of mucormycosis cases was seen due to the ongoing COVID pandemic and liberal use of corticosteroids in the treatment.

THE ROLE OF NASAL ENDOSCOPY IN PATIENTS OF MUCORMYCOSIS

Objective: The Rhino-orbital- cerebral infection is the most typical presentation of mucormycosis where there is an invasion of the fungal infection from paranasal sinuses to orbit and brain (6,11).Extension of the disease leads to vascular thrombosis, including the cavernous sinus and other cerebral vessels due to fibrin reaction and Mucor thrombus formation. Nasal Endoscopy aids in the early detection and management of the disease (8). This study aims to study the signs and symptoms of patients with mucormycosis and the role of nasal endoscopy in early diagnosis. Subjects And Methods: A Prospective study was conducted on 150 patients of age 20-90 years attending ENT OPD and admitted under the Department of otorhinolaryngology at a tertiary care center in Central India. Subjects with or without Covid 19 infection, comorbidities like diabetes and hypertension and patients on steroids were selected for nasal endoscopy. Patients with benign or malignant lesions of nasal cavity and post operative cases of FESS for mucor were excluded. Results: In out study, majority patients were from the 5th decade followed by the 6th. In the classification system designed on the basis of endoscopy findings, majority were in Group B(42%) followed by Group C (28.7%). Maxillary sinus was found to be the most common sinuses involved as seen in the MRI of 110 patients. Out of 150 patients, debridement was done in 74 patients. In our study, we have concluded that diagnostic nasal endosco Conclusion: py aids in early diagnosis and management of mucormycosis. The grading system makes the management of the large number of patients easier. Appropriate time, treatment and resources can be given to the required patients. All patients after this management protocol stood well and were successfully discharged with only 8% mortality rate.

Schwannoma in the nasal cavity: A benign nerve sheath tumor at an odd location

Schwannomas are neurogenic tumors arising from the Schwann cells present in the neural sheath of the myelinated nerves. These are benign tumors that can arise anywhere in the body. Schwannomas are rarely seen in the nose and paranasal sinuses representing &lt;4% of all head-and-neck schwannomas. Surgical excision is the treatment of choice in these cases. Nasal polyps are common nasal cavity lesions which are usually inflammatory polyps. Schwannoma of the nasal cavity usually presented with headache, unilateral nasal obstruction due to mass obliterating the nasal cavity, and epistaxis. Here, we report the case of a 47-year-old female who presented with a mass in the left nasal cavity causing the nasal blockage.

Role of radiology in post COVID-19 rhinocerebral fungal infections

The purpose of this study was to describe common radiographic patterns that may be useful in predicting the diagnosis of rhinocerebral mucormycosis. Methods: We retrospectively evaluated the imaging and clinical data of four males and one female, 3 to 72 years old, with rhinocerebral mucormycosis. Results: All the patients presented with sinusitis and ophthalmological symptoms. Most of the patients (80%) had isointense lesions relative to brain in T1-weighted images. The signal intensity in T2-weighted images was more variable, with only one (20%) patient showing hyperintensity. A pattern of anatomic involvement affecting the nasal cavity, maxillary sinus, orbit, and ethmoid cells was consistently observed in all five patients (100%). Our series demonstrated a mortality rate of 60%. Conclusion: Progressive and rapid involvement of the cavernous sinus, vascular structures and intracranial contents is the usual evolution of rhinocerebral mucormycosis. In the context of immunosupression, a pattern of nasal cavity, maxillary sinus, ethmoid cells, and orbit inflammatory lesions should prompt the diagnosis of mucormycosis. Multiplanar magnetic resonance imaging shows anatomic involvement, helping in surgery planning. However, the prognosis is grave despite radical surgery and antifungals.

Nasal Presentations of Rosai-Dorfman Disease: Clinical Manifestation and Treatment Outcomes.

There has been a lack of evidence-based management strategies on the nasal presentations of Rosai-Dorfman disease (RDD). We aim to investigate the clinical manifestation, treatment, and outcomes in patients with nasal RDD. We retrospectively reviewed available medical records of patients diagnosed with nasal RDD from 2014 to 2021 at our department. A total of 26 patients were included with a marked female preponderance (2.25:1). The most common symptom and affected sites were nasal congestion (31%) and nasal cavity (73%), respectively. The average times of biopsies was 1.5 times (range: 1-3). The histiocytes were positive about S100 and CD68 and negative for CD1a with common emperipolesis. The mean duration of follow-up was 34months (range, 3-87). One patient with concomitant nasal small B-cell lymphoma achieved complete remission after chemoradiotherapy. Recommended treatments were endoscopic resection (92%) and oral corticosteroids (21%). Surgery was performed to remove the resectable lesion as completely as possible. Corticosteroids induced almost 100% overall remission. Of the relapses, two patients achieved an overall response and one remained in progressive stage after subsequent excision. Two patients only received dissection biopsy that responded to oral corticosteroid administration and combined therapies of lenalidomide and dexamethasone, respectively. Diffuse lesions in nasal cavity and sinuses, and even widely affected nasal skull base, laryngopharynx, orbit, and cavernous sinus, should be considered the possibility of Rosai-Dorfman disease. Characteristic immunohistochemical staining is helpful for the diagnosis. Endoscopic surgical therapy remains the mainstream treatment for patients enduring an unbearable course. Oral corticosteroid administration serves as an adjuvant therapy for first-line treatments.

Differential diagnosis of a local form of granulomatosis with polyangiitis: nasal cavity and paranasal sinuses lesions (part 1)

Granulomatosis with polyangiitis (GPA) is a primary vasculitis associated with antineutrophil cytoplasmic antibodies, characterized by necrotizing vasculitis with predominant involvement of small vessels of various localizations and necrotizing granulomatous inflammation with multiple clinical manifestations. GPA remains one of the most severe systemic vasculitis with unfavorable prognosis. When analyzing the course of the disease, there are two variants of GPA, local (with lesions of the upper respiratory tract, URT, organs of vision and hearing) and generalized (with lesions of the URT, organs of vision and hearing in combination with the lungs and/or kidneys, gastrointestinal tract, nervous systems, skin involvement).The article discusses the differential diagnosis of the disease with the nasal cavity and paranasal sinuses lesions onset, which requires an interdisciplinary approach and interaction of doctors of different specialties.

Histopathological Spectrum of Sinonasal Masses in Patients Coming To a Tertiary Care Hospital: A Study of 150 Cases

Background: Sinonasal masses (SNMs) are a pretty frequent medical entity that take place amongst patients of all age groups. Their symptoms and signs regularly overlap, as a result a diagnostic predicament exists. A right analysis is prudent for instituting right cure and anticipating recovery. The purpose of this analysis was to find out the incidence &amp; variety of nonneoplastic &amp; neoplastic lesions of nasal cavity &amp; paranasal sinuses. Objectives: The aims of this study were to determine the histopathological spectrum of sinonasal masses in patients coming to a tertiary care hospital and also to compare the findings with other studies. Methods: This analysis was carried out on 150 patients with SNMs presented to the Department of Histopathology at National Institute of ENT &amp; Hospital, Dhaka, Bangladesh over a period of about two years (September 2016 to May 2018). Their demographic data, clinical profile and histopathological diagnosis were analyzed. Results: A total of 150 cases were studied. The neoplastic lesions formed the larger group, 87 cases (58%) followed by nonneoplastic lesions, 63 cases (42%). Nonneoplastic lesions were more common in the age group of 2nd &amp; 3rd decades while neoplastic masses were prevalent in the 2nd &amp; 6th decades. The lesions of nasal cavity &amp; paranasal sinuses had a stronger predilection for males as compared to females with the male to female ratio being 2.33. Conclusions: The majority of sinonasal masses sent for histopathology are inflammatory, a variety of benign &amp; malignant lesions may present as nasal masses. All nasal masses must need thorough histopathological examination.

Spectrum of histopathological lesions of nasal cavity, paranasal sinus and nasophrynx at tertiary care centre

Introduction: The lesions of nasal cavity and paranasal sinuses provides problems in their diagnosis, prognosis and management because of limited anatomical space and certain unusual clinicopathological features. Materials and Methods: The present study was carried out on 50 patients. Types of samples include biopsies or total specimens from nose, para nasal sinuses and nasophrynx received in histopathology section of the pathology department. The cases were diagnosed based routine H& E stained section slide via light microscopy. Aims and Objectives: To study the incidence of various non neoplastic and neoplastic lesion with, age and sex distribution along with their clinical presentation and various Histopathological patterns. Results: A total of 50 specimens from representative areas were studied. Age distribution varied from 0 to >70 years with male preponderance. Non - Neoplastic lesions were common comprising of 32 cases (54%) while neoplastic lesions were 23 (46%). Among non neoplastic lesions inflammatory polyp (12 cases) was common followed by allergic polyp (10 cases). In neoplastic lesions, squamous cell carcinoma (06 cases) predominated. Conclusion: It shows wide range of non neoplastic lesion in the complex region of nose, paranasal sinus and nasophrynx. Non neoplastic lesions were far common as compared with neoplastic lesion. Radiological studies and other investigation can help provide a differential diagnosis, but the final diagnosis can only be given on Histopathological examination. Definite diagnosis is essential for further management and to determine the prognosis of the patient. Therefore histopathology plays an integral role and remains gold standard for establishing the diagnosis of sinonasal tract pathology.

Two Cases of Herpes Virus Infection of Nose Mimicking Acute Invasive Fungal Infection in Immunocompromised Hosts

Various invasive fungal infections can occur in immunocompromised hosts, and an acute invasive fungal infection (AIFI) can be fatal. Because of its high mortality rate, AIFI must be quickly diagnosed and treated, such as anti-fungal agents or surgical debridement. In an immunocompromised host, nasal herpes simplex infection, usually caused by herpes simplex virus (HSV) type-1, can have various clinical manifestations, some of which can mimic AIFI. However, the management of acute viral infection differs significantly from invasive fungal infections of the nose. A fast and accurate differential diagnosis is mandatory because a delay in the disease-specific treatment of acute invasive infections can lead to mortality. This report describes two immunocompromised patients with mucosal and skin lesions around the nose. We provide clinical clues when mucosal lesions of the nasal cavity and skin lesions around the nose develop in immunocompromised hosts.

Role of Radiology in Mucormycosis: Recent Update

The purpose of this study was to describe common radiographic patterns that may be useful in predicting the diagnosisof rhinocerebral mucormycosis. Methods: We retrospectively evaluated the imaging and clinical data of four males andone female, 3 to 72 years old, with rhinocerebral mucormycosis. Results: All the patients presented with sinusitis andophthalmological symptoms. Most of the patients (80%) had isointense lesions relative to brain in T1-weighted images.The signal intensity in T2-weighted images was more variable, with only one (20%) patient showing hyperintensity. Apattern of anatomic involvement affecting the nasal cavity, maxillary sinus, orbit, and ethmoid cells was consistentlyobserved in all five patients (100%). Our series demonstrated a mortality rate of 60%. Conclusion: Progressive and rapidinvolvement of the cavernous sinus, vascular structures and intracranial contents is the usual evolution of rhinocerebralmucormycosis. In the context of immunosupression, a pattern of nasal cavity, maxillary sinus, ethmoid cells, and orbitinflammatory lesions should prompt the diagnosis of mucormycosis. Multiplanar magnetic resonance imaging showsanatomic involvement, helping in surgery planning. However, the prognosis is grave despite radical surgery andantifungals.

Histopathological Study of Lesions of Nasal Cavity and Paranasal Sinuses

Context: The lesions of nasal cavity and paranasal sinuses provides problem in their diagnosis, prognosis and management because of limited anatomical space and certain unusual clinicopathological features. Aims: The present study was undertaken to study the incidence &amp; frequency of various non-neoplastic and neoplastic lesions. It also aimed to describe the histomorphologic features of lesions of nasal cavity and paranasal sinuses. Settings and Design: This is a simple retrospective observational study. Methods and Materials: The material for present study was obtained as excisional biopsy of the lesions. The specimens were received in 10% formalin along with requisition form which also included the clinical data. The material was processed as routine histopathological examination. Special stains were done wherever required. Results: Total 62 cases were analyzed. The lesions were classified as non-neoplastic and neoplastic. The non-neoplastic lesions were classified according to classification given by Friedman and Osborn. Tumors of nasal cavity and paranasal sinus were classified according to WHO classification and observations compared with other studies. Conclusions: Non-neoplastic lesions were more common than neoplastic lesions. Sinonasal polyps were the most common lesions in the present study (50%). The age incidence ranges from 1st decade to 7th decade. There was slight female preponderance. The incidence of malignant tumours was slightly more than the benign tumours. Thus categorizing the sinonasal lesions according to histopathological features into various types helps clinicians to know the clinical presentation, the best management, clinical outcome and prognosis of the disease. Keywords: Histopathology, Nasal, paranasal, Sinonasal, Polyp, WHO

Radiological aspects in mucormycosis

The purpose of this study was to describe common radiographic patterns that may be useful in predicting the diagnosis of rhinocerebral mucormycosis. Methods: We retrospectively evaluated the imaging and clinical data of four males and one female, 3 to 72 years old, with rhinocerebral mucormycosis. Results: All the patients presented with sinusitis and ophthalmological symptoms. Most of the patients (80%) had isointense lesions relative to brain in T1-weighted images. The signal intensity in T2-weighted images was more variable, with only one (20%) patient showing hyperintensity. A pattern of anatomic involvement affecting the nasal cavity, maxillary sinus, orbit, and ethmoid cells was consistently observed in all five patients (100%). Our series demonstrated a mortality rate of 60%. Conclusion: Progressive and rapid involvement of the cavernous sinus, vascular structures and intracranial contents is the usual evolution of rhinocerebral mucormycosis. In the context of immunosupression, a pattern of nasal cavity, maxillary sinus, ethmoid cells, and orbit inflammatory lesions should prompt the diagnosis of mucormycosis. Multiplanar magnetic resonance imaging shows anatomic involvement, helping in surgery planning. However, the prognosis is grave despite radical surgery and antifungals.

Clinicopathological study of lesions of nasal cavity and paranasal sinuses- A two year study

Sinonasal masses are common in the ENT Outpatient Department. The incidence being 1-4% of population. The symptoms and signs frequently overlap, hence, a diagnostic dilemma exists. The aim of this study was to study the occurrence of various lesions, the age, site and sex wise distribution in a tertiary care hospital of Maharashtra over the period of two years. The study aims to examine the occurrence of various lesions in nasal cavity and paranasal sinuses, to determine the age, sex and site wise incidence of different benign and malignant lesions of nasal cavity and paranasal sinuses and to correlate the clinical and histopathological findings. Descriptive Study A descriptive study was carried out in the Department of Pathology at Tertiary Health Care among patients with clinically diagnosed nasal and paranasal sinus lesions attending the OPD of ENT during a period of 2 years. The specimens were grossly examined; fixed and routine microscopic staining was done. Interpretation was done using colour of the nuclei and the specimens were classified as neoplastic and non-neoplastic lesions. The data was statistical analysed. Mean, Median, Mode The most common clinical presentation was nasal obstruction 97 (93.26%), rhinorrhoea 73 (70.19%) and facial pain 24 (23%). 1: Mean age for the lesions to occur was years with the range 21-30 years (20.92%); 2: Non-neoplastic lesions 82 (79.6%) were more common than neoplastic lesions; 3: Simple nasal polyp 74 (90.23%), hemangiomas (50%) and squamous cell carcinoma (50%) were most common. The study concludes that complete clinical, radiological and histopathological correlation helps us to categorize these sino-nasal lesions into various non-neoplastic and neoplastic types. But final histopathological examination provides a confirmatory diagnosis, as a significant number of cases may be missed on clinical evaluation alone.The clinical features of non-neoplastic and neoplastic nasal and paranasal sinuses lesions may be indistinguishable from each other leading to delay in proper diagnosis and treatment. Histopathological examination is a reliable, cost effective diagnostic tool for accurate diagnosis and management of such lesions, as a significant number of cases may be missed on clinical evaluation alone.

HPV-Related Multi-Phenotypic Sinonasal Carcinoma with Aggressive Clinical Behavior; A Rare Case

Abstract Introduction/Objective Human Papilloma Virus (HPV)-related multiphenotypic sinonasal carcinoma, previously known as HPV-related sinonasal carcinoma with adenoid cystic carcinoma-like features, is a rare type of sinonasal carcinoma with both epithelial-derived and salivary gland-type morphologic features. It is associated with high-risk HPV, but lacks MYB gene rearrangements. Methods/Case Report We report a case of a 59-year-old male who presented with a rapidly growing sinonasal mass. On MRI, a left nasal cavity lesion was identified growing laterally along the frontal process of the maxilla, extending into the middle meatus and into the maxillary sinus. Patient underwent a complex left medial maxillectomy, spheno- ethmoidectomy, and sinusotomy. On gross evaluation, the left inferior turbinate and sidewall demonstrated a 4 cm unremarkable turbinate with attached friable soft tissue. Microscopic examination revealed sections of carcinoma with various architectural patterns comprised of foci with adenoid cystic carcinoma-like morphology, basaloid squamous cell carcinoma and adenocarcinoma. The tumor showed positive immunostaining for P40, but focal reactivity to S100 and rare scattered reactivity with CD117. INI-1 immunostain was retained in tumor cells. P16 immunostain was strong and diffuse and high-risk cocktail HPV RNA ISH was positive. However, MYB FISH testing was equivocal. Morphologic and immunophenotypic findings were consistent with HPV-related multiphenotypic sinonasal carcinoma. The tumor involved the olfactory nerve fibers requiring a skull base resection and showed extension into the dura mater. Results (if a Case Study enter NA) NA Conclusion HPV related multiphenotypic sinonasal carcinoma is a recently described entity that can pose significant diagnostic challenge. It typically has an indolent clinical course with potential for late recurrences. This case study highlights the potential aggressive nature of this type of sinonasal carcinoma, despite association with high-risk HPV, and use of ancillary testing in aiding diagnosis.

Role of Radiology in Mucormycosis: Recent Trends

Background and Objectives: The purpose of this study was to describe common radiographic patterns that may be useful in predicting the diagnosis of rhinocerebral mucormycosis. Methods:We retrospectively evaluated the imaging and clinical data of four males and one female, 3 to 72 years old, with rhinocerebral mucormycosis. Results: All the patients presented with sinusitis and ophthalmological symptoms. Most of the patients (80%) had isointense lesions relative to brain in T1-weighted images. The signal intensity in T2-weighted images was more variable, with only one (20%) patient showing hyperintensity. A pattern of anatomic involvement affecting the nasal cavity, maxillary sinus, orbit, and ethmoid cells was consistently observed in all five patients (100%). Our series demonstrated a mortality rate of 60%. Conclusion: Progressive and rapid involvement of the cavernous sinus, vascular structures and intracranial contents is the usual evolution of rhinocerebral mucormycosis. In the context of immunosupression, a pattern of nasal cavity, maxillary sinus, ethmoid cells, and orbit inflammatory lesions should prompt the diagnosis of mucormycosis. Multiplanar magnetic resonance imaging shows anatomic involvement, helping in surgery planning. However, the prognosis is grave despite radical surgery and antifungals.

English

BACKGROUND Rhino-orbito-cerebral mucormycosis (ROCM) is a life-threatening infection caused by saprophytic fungi. The purpose of this study was to describe common radiographic patterns that may be useful in predicting the diagnosis and assessing the extent of involvement of rhino-orbito-cerebral mucormycosis in Covid and post Covid patients. METHODS The case records of patients with rhino-orbito-cerebral mucormycosis were reviewed. This included 200 patients of which 122 were males and 78 females, with a minimum age of 22 to a maximum of 80 years old. Computed tomography (CT) and / or magnetic resonance imaging (MRI) images were retrieved from the picture archiving and communication system (PACS) and analysed. Statistical analysis was performed using descriptive statistics. RESULTS All the patients showed sinusitis and ophthalmological symptoms. CT and MR imaging showed predominant involvement of the maxillary (196, 98 %) and ethmoid (194, 97 %) sinuses. Involvement of the orbit (186, 93 %) and face (114, 57 %) preceded involvement of the pterygopalatine fossa (90, 45 %) and brain (52, 26 %). CT showed minimally enhancing hypodense soft tissue thickening as the predominant finding in involved areas, while MRI showed T2 isointense to mildly hypointense soft tissue thickening and heterogeneous post-contrast enhancement as the main finding. In patients with extra sinus extension, bone erosion was seen in 80 patients (40 %) but few (20, 10 %) of the patients showed extension across grossly intact appearing bones. CONCLUSIONS In the context of Covid-19 with immunosuppression, a pattern of the nasal cavity, maxillary sinus, ethmoid cells, and orbit inflammatory lesions should prompt the diagnosis of mucormycosis. Progressive and rapid involvement of the cavernous sinus, vascular structures and intracranial contents can occur. Multiplanar magnetic resonance imaging and computed tomography show anatomic involvement, helping in surgery planning. KEY WORDS Rhino-Orbito-Cerebral mucormycosis, Imaging Findings, MRI, Neuroradiology

Role of imaging in mucormycosis

Background and objectives: The purpose of this study was to describe common radiographic patterns that may be useful in predicting the diagnosis of rhinocerebral mucormycosis. Methods: We retrospectively evaluated the imaging and clinical data of four males and one female, 3 to 72 years old, with rhinocerebral mucormycosis. Results: All the patients presented with sinusitis and ophthalmological symptoms. Most of the patients (80%) had isointense lesions relative to brain in T1-weighted images. The signal intensity in T2-weighted images was more variable, with only one (20%) patient showing hyperintensity. A pattern of anatomic involvement affecting the nasal cavity, maxillary sinus, orbit, and ethmoid cells was consistently observed in all five patients (100%). Our series demonstrated a mortality rate of 60%. Conclusion: Progressive and rapid involvement of the cavernous sinus, vascular structures and intracranial contents is the usual evolution of rhinocerebral mucormycosis. In the context of immunosupression, a pattern of nasal cavity, maxillary sinus, ethmoid cells, and orbit inflammatory lesions should prompt the diagnosis of mucormycosis. Multiplanar magnetic resonance imaging shows anatomic involvement, helping in surgery planning. However, the prognosis is grave despite radical surgery and antifungals.