Isolated Posterior Ethmoidal Aspergilloma : A rare presentation of fungal rhinosinusitis olated

Abstract

Introduction

Fungal rhinosinusitis encompasses a spectrum of diseases involving the nasal and paranasal sinuses. It can be broadly classified into invasive and noninvasive categories depending upon the vascular invasion. Aspergilloma or fungal ball is  a non invasive type of fungal sinusitis which is caused by fungus , Aspergillus, identified by  a non septate hyphae . It is mainly seen in immunocompetent individuals involving the maxillary sinus. The involvement of posterior ethmoid sinus is rarely noted.

Case report

A 55 year old  diabetic male presented to us with unilateral nasal obstruction and headache for two years . On examination, there was left sided  Osteomeatal complex  blockage .  Computed tomography of the paranasal sinuses demonstrated an isolated heterogenous opacity involving the left posterior ethmoid region. The pt was taken up for functional endoscopic c sinus surgery under general anesthesia. Intraoperatively fungal debris was seen identified within the left posterior ethmoid sinus and was completely removed. Histopathology showed Aspergilloma confirming the diagnosis of an isolated posterior ethmoidal fungal ball. The postoperative course was uneventful. At six months follow up , nasal endoscopy showed a healthy postoperative cavity without any residual or recurrent disease.

Discussion

Fungal ball is a non invasive form of fungal rhinosinusitis characterized by accumulation of fungal elements within a sinus without tissue invasion. Isolated posterior ethmoidal involvement is uncommon and may present with nonspecific symptoms resulting in delayed diagnosis. Computed tomography plays an important role in identifying the involved sinus and the extent and helps to distinguish from invasive forms. Complete endoscopic clearance and restoration of sinus ventilation constitute the mainstay of treatment.

Conclusion

Isolated posterior ethmoidal aspergilloma is an uncommon presentation of fungal rhinosinusitis .It should be considered in the differential diagnosis of a persistent unilateral heterogenous posterior ethmoidal opacity. Endoscopic surgical clearance provides effective treatment with a favorable outcome