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. 2019 Nov 19;99(43):3417-3419.
doi: 10.3760/cma.j.issn.0376-2491.2019.43.013.

[Value of CT in the differential diagnosis of Pseudomonas aeruginosa sinusitis and fungal ball in paranasal sinus caused by Aspergilus flavus]

[Article in Chinese]
X L Chen  1 , J F Xian  1 , X X Lu  2
Affiliations

[Value of CT in the differential diagnosis of Pseudomonas aeruginosa sinusitis and fungal ball in paranasal sinus caused by Aspergilus flavus]

[Article in Chinese]
X L Chen et al. Zhonghua Yi Xue Za Zhi. .

Abstract
in English, Chinese

Objective: To evaluate the value of CT in the differential diagnosis of Pseudomonas aeruginosa sinusitis and fungal ball in paranasal sinus caused by Aspergilus flavus. Methods: In this retrospective study, CT results of 74 cases of Pseudomonas aeruginosa sinusitis including 31 male cases and 43 female cases with age onset from 15 to 74 years old (mean±SD was 50±13) and 72 cases of fungal ball in paranasal sinus caused by Aspergilus flavus including 28 male cases and 44 female cases with age onset from 25 to 78 years old (mean±SD was 53±15) at Beijing Tongren Hospital confirmed by histopathology were enrolled from January 2013 to May 2017. The CT characteristics of the two groups of cases were compared using χ(2) test, and P<0.05 was considered statistically significant. Results: Soft tissue opacification of the involved paranasal sinus was found on CT in each case of the two groups. There were significant differences in the rate of single sinus involvement (44.6% and 90.3% respectively), the incidence of lesion associated with maxillary sinus (91.9% and 70.8% respectively), ethmoid sinus (41.9% and 2.8% respectively), frontal sinus (29.7% and 0 respectively), calcification (50.0% and 72.2% respectively), and the enlargement of maxillary sinus opening (13.2% and 35.3% respectively), in addition to the central calcification (83.8% and 59.6% respectively) between the two groups (all P<0.05). However, the incidence of sphenoid sinus involvement (32.4% and 34.7% respectively), bone sclerosis (56.8% and 62.5% respectively) or destruction(18.9% and 16.7% respectively) were not found different between the two groups (P>0.05). Conclusion: Though the CT findings are similar between the two diseases such as soft tissue opacification of the involved paranasal sinus with calcification and bone sclerosis or destruction, there are still a few characteristics on CT in differentiating the one from the other. The involvement of multi-sinuses, maxillary sinus, ethmoid sinus and frontal sinus, the central calcification are more common in the Pseudomonas aeruginosa sinusitis. However, the CT features including single sinus involvement, calcification and enlargement of maxillary sinus opening, can be seen more often in the fungal ball in paranasal sinus caused by Aspergilus flavus.

目的： 通过比较绿脓杆菌所致鼻窦炎和黄曲霉菌所致鼻窦真菌球CT特征，探讨CT鉴别诊断价值。 方法： 收集2013年1月至2017年5月北京同仁医院确诊的74例绿脓杆菌所致鼻窦炎[男31例、女43例，年龄15~74（50±13）岁]和72例黄曲霉菌所致鼻窦真菌球[男28例、女44例，年龄25~78（53±15）岁]患者的CT资料。回顾性比较二者CT特征，统计学方法用χ(2)检验，P<0.05为差异有统计学意义。 结果： 二者CT均表现为鼻窦内软组织密度影（100%），病变范围累及单窦（44.6%和90.3%）、上颌窦（91.9%和70.8%）、筛窦（41.9%和2.8%）、额窦（29.7%和0）、伴钙化（50.0%和72.2%）、上颌窦口扩大（13.2%和35.3%）、中央钙化（83.8%和59.6%）的差异有统计学意义（均P<0.05），而在累及蝶窦（32.4%和34.7%）、窦壁增生硬化（56.8%和62.5%）或破坏吸收（18.9%和16.7%）上差异无统计学意义（均P>0.05）。 结论： 绿脓杆菌所致鼻窦炎和黄曲霉菌所致鼻窦真菌球均可表现为窦腔软组织影伴钙化、窦壁增生硬化或破坏吸收，但前者常多窦受累，易累及上颌窦、筛窦、额窦，钙化相对少见且多位于受累鼻窦的中央；而后者多累及单窦，上颌窦受累最多见，其次为蝶窦，而额窦及筛窦受累少见，钙化更常见且易发生于受累鼻窦的窦口，多伴窦口扩大。.

Keywords: Fungi; Paranasal sinuses; Tomography, X-Ray Computed.

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