A 60-year-old woman has long-standing left-sided nasal obstruction with foul-smelling discharge but no facial pain. CT shows complete opacification of the left maxillary sinus with a rounded hyperdense mass containing punctate central calcifications, and no bone destruction or mucosal thickening elsewhere. What is the diagnosis and appropriate treatment?

• A Allergic fungal sinusitis, systemic corticosteroids with FESS
• B Invasive fungal sinusitis, urgent debridement and amphotericin B
• C Antrochoanal polyp, Caldwell-Luc operation
• D Fungus ball (aspergilloma), complete endoscopic removal of the mass via FESS ✓

Explanation

A fungus ball is a non-invasive, extramucosal fungal mass, almost always Aspergillus, typically in a single maxillary sinus of an immunocompetent older patient. The hallmark CT findings are opacification with punctate or curvilinear calcification and absence of bone erosion. Treatment is complete endoscopic evacuation through widened antrostomy; antifungal drugs are not needed. Allergic fungal sinusitis shows heterogenous hyperattenuation with bony remodelling and eosinophilic mucin, while invasive disease occurs in the immunocompromised.

Reference: Cummings Otolaryngology Head and Neck Surgery, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.