[Presentation and management of allergic fungal rhinosinusitis in children]

Abstract

Objective:To assess the presentation of allergic fungal rhinosinusitis（AFRS） in children and the role of long-term comprehensive therapy of endoscopic surgery combined with drug therapy. Methods:The 3 children with AFRS were routinely examined by nasal endoscopy, CT scan, MRI scan and allergen detection before surgery, and mycological and histomathological examination were performed on the secretions in the sinus and the mucosa of the affected sinuses. All the 3 patients underwent endoscopic surgery, preoperative and postoperative treatment with oral and nasal corticosteroid, nasal irrigation, and individualized anti-allergy therapy and immunotherapy. The patients were followed up for 3 to 12 months. Results:All 3 children had nasal polyps and headache, and 2 children had exophthalmos and facial asymmetry. There were typical CT and MRI findings on imaging. Serum total IgE were all elevated, and 2 cases were positive for fungal SIgE. All 3 children underwent endoscopic surgery. Fungal hyphae and spores were found in 1 child, and other fungi tests were positive in another 2 children. Postoperative facial asymmetry was relieved spontaneously, and mucosal swelling and polypoid changes were observed in 2 children. Conclusion:AFRS is a specific type of chronic rhinosinusitis that is not uncommon in children. Early diagnosis, prompt operation, standardized treatment and long-term follow-up are very important in the diagnosis and treatment of AFRS in children.

Keywords: child; fungi; hypersensitivity; sinusitis.

图 1

例1患儿术前影像学检查  1a、1b：分别显示CT轴状位和冠状位，示左侧全组鼻窦内及鼻腔扩大，见软组织影填充，局部见斑片状高密度影；1c：CT重建，显示左侧鼻背增宽，鼻中隔明显受压右偏；1d：MRI STIR序列冠位，显示左侧上颌窦窦腔扩大，内见条片状STIR序列高信号影；  图 2  例1患儿术后影像学检查   2a：术后3个月，左侧上颌窦前壁局部黏膜轻度增厚，密度均匀；2b：术后8个月，左侧上颌窦前、后壁黏膜明显增厚，呈息肉样改变；2c：术后12个月，左侧上颌窦黏膜增厚较前好转，未见明显息肉复发；  图 3  例2患儿术前影像学检查及术中所见  3a、3b分别为CT轴状位和冠状位，显示双侧全组鼻窦窦腔、鼻腔扩大，见软组织密度影填充，局部见片状高密度影，双侧上颌窦窦口扩大；3c：MRI T2WI序列冠状位，显示双侧筛窦、上颌窦黏膜增厚，双侧筛窦窦腔完全被短T2信号影填充；3d：术中取出的黏蛋白和灰褐色团块；  图 4  例2患儿术后影像学检查  4a：术后3个月，双侧筛窦、上颌窦黏膜增厚，密度均匀，以右侧显著；4b：术后6个月，双侧鼻窦炎较前明显加重，窦腔黏膜明显增厚，密度均匀，未见明显钙化影；4c：术后8个月，双侧筛窦、上颌窦炎较前有所吸收好转，密度均匀；4d、4e：术后1年，双侧全组鼻窦内软组织影伴磨玻璃样改变；  图 5  例3患儿术前影像学检查  5a、5b：分别为CT轴状位和冠状位，显示左侧上颌窦窦腔及鼻腔扩大，内见软组织影填充，密度不均匀，内见线状钙化影；5c：MRI T1WI序列轴位像，显示左侧上颌窦黏膜明显增厚，呈T1WI序列低/等信号。