A 40-year-old immunocompetent man has years of unilateral facial fullness. CT shows complete opacification of the right maxillary sinus with a central hyperdense focus resembling a tooth or calcification, with no bone destruction. Endoscopy is normal. What is the appropriate management?

• A Intravenous amphotericin B followed by radical maxillectomy
• B Oral itraconazole for 6 weeks followed by repeat imaging
• C Complete endoscopic surgical removal of the mass; no systemic antifungal therapy is required ✓
• D Systemic corticosteroids and saline irrigations alone

Explanation

This is a fungus ball, a noninvasive fungal disease seen in immunocompetent patients, almost always in one maxillary sinus. The CT shows a dense radiopacity with calcification inside an opacified sinus without bony erosion. Curative treatment is complete surgical evacuation of all fungal debris through an endoscopic approach. Systemic antifungals are unnecessary because there is no tissue invasion, which distinguishes it from invasive fungal sinusitis.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.