"Expansion of the involved sinus, with remodelling and thinning of its bony walls, is seen in almost all patients with complete sinus opacification 3. Bone erosion is more variable (between 33% and >90% depending on the series) 2,3,10.."
"While allergic fungal rhinosinusitis is defined by a type I hypersensitivity response to fungal elements, histologically identical cases without demonstrable fungi occur. Some authors therefore regard the eosinophilic mucin, rather than the fungus, as the defining feature, giving rise to the term eosinophilic mucin rhinosinusitis. Inconsistently, this term was proposed to refer to non-fungal disease, while other authors applied it as an umbrella term encompassing both the fungal and non-fungal variants. The latter is often bilateral and associated with aspirin-exacerbated respiratory disease. The distinction is ultimately histopathological and mycological, as the two are not reliably separable on imaging 5,6."
"The Bent and Kuhn criteria remain the most widely used for diagnosis 4,6,7. All five major criteria are required for the diagnosis:"
"dematiaceous (pigmented) fungi: Bipolaris, Curvularia, Alternaria"
"hyaline moulds: Aspergillus, Fusarium"
Expected headings
"Associations"
"Signal characteristics"
"Allergic fungal rhinosinusitis is the most common form of fungal rhinosinusitis and is common in warm, humid climates 2,7. On imaging, it usually presents as opacification and expansion of multiple paranasal sinuses, unilaterally or bilaterally, with content that is centrally hyperdense on CT. MRI shows T2 hypointensity centrally due to dense fungal concretions and heavy metals."
"Minor criteria, which support but do not establish the diagnosis, are asthma, unilateral predominance, radiographic bone erosion, positive fungal culture, Charcot-Leyden crystals in the surgical specimen, and serum eosinophilia 7."
"Allergic fungal rhinosinusitis usually involves multiple sinuses and can be unilateral or bilateral (the latter is more common) 3. There is frequently a nasal component. The ethmoid sinus is the most common location, followed by the maxillary, frontal, and sphenoid sinuses 7."
"central allergic mucin is variable signal, most often hypointense to isointense, reflecting its high protein content; occasionally it can be hyperintense 7"
"Allergic fungal rhinosinusitis is usually treated with local excision and steroid therapy 7. Antifungal therapy is also attempted in some cases, but results are equivocal 7. Recurrence after surgery is not uncommon; however, the inclusion of steroid therapy significantly reduces relapse 7,9."