A 40-year-old immunocompetent woman with years of nasal fullness has a CT showing complete opacification of the right maxillary sinus with central hyperdense material and partial walls of calcification, without bone destruction or mucosal thickening elsewhere. Endoscopy is normal. What is the most likely diagnosis?

• A Acute invasive fungal sinusitis
• B Chronic invasive granulomatous fungal sinusitis
• C Antrochoanal polyp
• D Fungal ball (mycetoma) of the maxillary sinus ✓

Explanation

A fungal ball occurs in immunocompetent hosts as a noninvasive mass of dense hyphae, almost always in a single maxillary sinus, showing intralesional calcification or metal-like hyperdensity on CT with minimal mucosal inflammation and no bone destruction. Invasive fungal disease shows soft tissue destruction and occurs in immunocompromised patients, and an antrochoanal polyp appears as a smooth water-density mass extending through the choana.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.