变应性真菌性鼻窦炎累及眼部的CT诊断

目的 探讨变应性真菌性鼻窦炎累及眼部的CT表现。资料与方法回顾性分析6例经病理组织学证实的变应性真菌性鼻窦炎，均出现眼部症状，包括突眼5例，眼球移位4例，视力减退3例；鼻部主要症状为奶酪状黏涕、鼻塞。结果6例变应性真菌性鼻窦炎均累及双侧多个鼻窦。CT平扫示受累鼻窦窦腔充满软组织影，伴有多发条状、葡行性或斑片状高密度影(软组织窗)，边界清楚，也可伴有磨玻璃状高密度影(骨窗)，边界较模糊；鼻窦膨胀．窦壁骨质变形、变薄、连续中断。病变累及眼眶，4例侵犯眶内壁，1例侵犯眶上壁，1例同时侵犯眶内、上壁．与邻近眼外肌分界不清；眶尖容积变小2例，6例眼球均不同程度突出。结论双侧鼻窦充满软组织影，伴有条状或葡行高密度影是诊断本病的特征性CT征象，根据此征象可提出本病的诊断；本病进展期常侵犯眼眶，有时患者可能以眼部症状首先就诊，应引起临床及影像科医师的重视。

CT Diagnosis of Orbital Involvement in Allergic Fungal Sinusitis

Objective To discuss CT features of orbital involvement in allergic fungal sinusitis.Materials and Methods Clinical manifestations and CT findings in 6 cases with histopathologically proved allergic fungal sinusitis were retrospectively analyzed. All patients had ophthalmic symptom, including proptosis (n=5), global displacement (n=4) and diminution of vision (n=3). The main rhinal symptoms were cheese-like mucous discharge and nasal obstruction.Results Bilateral multiple sinuses were involved in all patients. On plain CT scans, the affected nasal sinuses were filled with soft-tissue shadow, with multiple streak, serpiginous or patchy hyper-density well-defined shadow (under soft-tissue window), or with ground-glass hyper-density ill-defined shadow (under bone window). Other findings included expanded sinus cavity and deformed, thinned or interrupted bony wall. The orbit was affected. The involvement was at medial wall (n=4), superior wall (n=1), both walls (n=1, being difficult to demarcate the lesion from the adjacent extraocular muscles), reduced orbital apex volume (n=2), and proptosis of different degree (n=6). Conclusion The characteristic CT signs of orbital involvement in allergic fungal sinusitis are soft-tissue-filled bilateral nasal sinuses with linear or serpiginous hyper-density shadow, based on which the diagnosis can be suggested. During its advanced stage, the orbit is often affected. The rhinal symptoms may be the initial cause to bring the patient to consult a physician. Both clinician and radiologist should have an alert mind to this disease.