变应性真菌性鼻窦炎的CT诊断

目的 探讨变应性真菌性鼻窦炎的CT表现及其诊断价值。方法 回顾性分析12例经术后组织病理证实的变应性真菌性鼻窦炎，均经过CT检查。主要临床表现包括奶酪状黏涕、鼻阻塞感及鼻区痛。鼻内镜检查：12例受累侧鼻腔内均可见息肉、黏膜水肿，鼻窦腔内均见真菌分泌物。结果 变应性真菌性鼻窦炎累及半组鼻窦3例，累及全组鼻窦9例。CT平扫12例表现为鼻窦黏膜增厚；窦腔内充满软组织影，伴有不规则条状、匍行性或斑片状高密度影(软组织窗)，边界清楚，也可伴有云雾状高密度影(骨窗)，边界模糊；CT值80～110HU，平均92．5HU。11例鼻窦膨胀，窦壁骨质变形、变薄10例，8例窦壁骨质侵蚀。8例病变延伸到邻近结构，其中4例累及眼眶，2例累及颅内，2例同时累及眼眶和颅内。结论 半组或全组鼻窦充满软组织影，伴有多发典型的高密度影是诊断本病的特征性CT征象，根据此征象可能首先提出本病的诊断。CT不但可以准确显示病变累及的范围，也能够帮助与其他病变进行鉴别。

CT diagnosis of allergic fungal sinusitis

Objective To study the CT features of allergic fungal sinusitis and to assess the CT diagnostic value. Methods Twelve cases of allergic fungal sinusitis verified by histopathology were retrospectively analyzed. The main clinical findings included cheese-like tenacious discharge, nasal obstruction, and nasal region pain. At endoscopy, nasal polyps, mucosal edema in the nasal cavity, and fungal material in the involved sinus were detected in all 12 cases. Results In 12 patients, all the unilateral pansinuses were involved in 3 and pansinuses were involved in 9. Mucosal thickening and soft tissue filling within the sinus cavity were showed on unenhanced CT in all 12 cases. The lesions showed well-defined irregular linear, serpiginous, or patchy increased attenuation within the completely opacified sinuses on reconstructed soft tissue window. CT also demonstrated hazy homogenous fog-like increased intrasinus attenuation on bone window. The CT value of the above mentioned densities ranged from 80 to 110 HU (mean 92. 5 HU). Of the 12 patients, 11 had expansion of the involved sinus, 10 had remodeling and thinning of the bony sinus wall, and 8 had erosion of the sinus wall. In 8 cases, the lesion extended into adjacent structures, including intraorbital extension in 4 patients, intracranial extension in 2 patients, and both sites simultaneously in 2 patients. Conclusion On unenhanced CT scans, allergic fungal sinusitis typically showed signs of unilateral or bilateral pansinusitis with soft tissue filling within the sinus and multiple increased attenuation shadows. Allergic fungal sinusitis may be initially suggested from the typical CT findings. These findings should alert the clinician to consider the possibility of the disease. CT can accurately show the extent of the disease and may be valuable in differential diagnosis.