Answer for CoW 04 December 2016
Rhinocerebral mucormycosis
Findings
There is a mucosal thickening noted in posterior ethmoidal sinus and soft tissue thickening noted in posterior aspect and intraconal aspect of left orbit extending into superior orbital fissure and cavernous sinus, which shows enhancement on contrast. Left optic nerve shows diffusion restriction. Multiple junctional zone infarcts noted in left centrum semiovale and left occipital lobe. Left internal carotid artery narrowed at petrous part and filling defect noted in supraclinoid part of left internal carotid artery. Features suggestive of MUCORMYOSIS with left orbital cellulitis, posterior ethmoidal sinusitis, Left optic nerve infarct ,left cavernous sinus inflammation and left internal carotid artery narrowed at petrous part with filling defect in supraclinoid part of left internal carotid artery.
Discussion
Rhinocerebral mucormycosis (RM) refers to an uncommon form of invasive fungal sinus infection. The presentation can vary ranging from exophthalmos, rhinorrhoea, and ophthalmoplegia with some patients rarely having loss of visual acuity and peripheral facial palsies. Risk groups:diabetics, especially those with poor control & immunocompromised states. MRI sinuses and brain- Reported signal characteristics include T1 (non contrast): isointense lesions relative to brain in most cases (~80%) T2:variable with around 20% of patients showing high T2 signal. fungal elements themselves tend to have low signal on T2. T1 C+ (Gd): the devitalised mucosa appears on contrast-enhanced MR imaging as contiguous foci of nonenhancing tissue : this gives a black turbinate sign. Complications:Invasion: Orbital spread. Intracranial extension Vascular thrombosis (from extension): including the cavernous sinus thrombosis 10 Subsequent infarction.
Findings
There is a mucosal thickening noted in posterior ethmoidal sinus and soft tissue thickening noted in posterior aspect and intraconal aspect of left orbit extending into superior orbital fissure and cavernous sinus, which shows enhancement on contrast. Left optic nerve shows diffusion restriction. Multiple junctional zone infarcts noted in left centrum semiovale and left occipital lobe. Left internal carotid artery narrowed at petrous part and filling defect noted in supraclinoid part of left internal carotid artery. Features suggestive of MUCORMYOSIS with left orbital cellulitis, posterior ethmoidal sinusitis, Left optic nerve infarct ,left cavernous sinus inflammation and left internal carotid artery narrowed at petrous part with filling defect in supraclinoid part of left internal carotid artery.
Discussion
Rhinocerebral mucormycosis (RM) refers to an uncommon form of invasive fungal sinus infection. The presentation can vary ranging from exophthalmos, rhinorrhoea, and ophthalmoplegia with some patients rarely having loss of visual acuity and peripheral facial palsies. Risk groups:diabetics, especially those with poor control & immunocompromised states. MRI sinuses and brain- Reported signal characteristics include T1 (non contrast): isointense lesions relative to brain in most cases (~80%) T2:variable with around 20% of patients showing high T2 signal. fungal elements themselves tend to have low signal on T2. T1 C+ (Gd): the devitalised mucosa appears on contrast-enhanced MR imaging as contiguous foci of nonenhancing tissue : this gives a black turbinate sign. Complications:Invasion: Orbital spread. Intracranial extension Vascular thrombosis (from extension): including the cavernous sinus thrombosis 10 Subsequent infarction.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!