A 40-year-old immunocompetent woman with years of nasal fullness has a CT showing a completely opacified right maxillary sinus containing discrete hyperdense calcifications within thick inspissated material, with no bony destruction and no polyposis. Endoscopy is normal. What is the diagnosis and appropriate management?
- A Allergic fungal sinusitis; systemic corticosteroids and antifungals
- B Chronic invasive fungal sinusitis; liposomal amphotericin B
- C Fungus ball (mycetoma); complete endoscopic surgical evacuation ✓
- D Antrochoanal polyp; Caldwell-Luc operation
Correct answer: C. Fungus ball (mycetoma); complete endoscopic surgical evacuation
Explanation
A fungus ball is a noninvasive fungal disease of an immunocompetent host, almost always involving one maxillary sinus, with characteristic intraluminal calcifications on CT and intact mucosa. Treatment is complete endoscopic removal of all fungal debris with wide antrostomy; antifungals are not required. Allergic fungal sinusitis shows diffuse polyposis and expansion with bony remodeling, while invasive disease requires systemic amphotericin because of tissue invasion.
Reference: Scott-Brown's Otorhinolaryngology Head and Neck Surgery, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.