Although AFS is known to result in bone erosion, invasive complications are rare. The clinical and pathologic information were reviewed. A literature review was

performed to clarify the clinical, radiologic, and pathologic features of AFS. The clinical and radiographic presentations were typical for AFS, including the relatively common complication of sinus wall erosion. Follow-up imaging demonstrated spread of fungal disease into the adjacent masticator space and intracranial spread by foramen ovale. This case illustrates the importance of identifying AFS and describing findings such as sinus erosion that may alter management. In this example, knowledge of the altered anatomy and potential learn more for mucosal injury may facilitate surgical planning and decrease the likelihood of future complications. The patient was a 14-year-old female who initially presented to her pediatrician with chronic sinus congestion, gray drainage, and facial swelling with asymmetry. These symptoms prompted a sinus CT scan and referral to an otolaryngologist. The CT scan (Fig 1) demonstrated findings compatible with allergic fungal sinusitis (AFS), including high attenuation secretions, marked Saracatinib sinus expansion, and multiple areas of bony thinning and focal dehiscence.[1] In particular, there was a large erosion involving the lateral wall of her right sphenoid sinus. Despite initial conservative management with nasal irrigation and steroids, the symptoms persisted,

and endoscopic sinus surgery was performed with bilateral ethmoidectomies, maxillary antrostomies, frontal sinus exploration, and sphenoid osteotomy. She was also treated at this time with antibiotics because of a positive pseudomonas culture. Although her initial postoperative course was uncomplicated, sinus drainage persisted and she developed jaw pain. A dental workup at this time was unremarkable. Her condition suddenly worsened a year later when she experienced two seizures and was taken to the emergency department for further evaluation. MR imaging

workup at this time revealed a peripherally enhancing mass with restricted diffusion extending from the infratemporal fossa into the middle cranial fossa (Fig 2). On the basis of these imaging findings, the differential considerations 上海皓元 included abscess or neoplasm, such as lymphoma or primary head and neck tumor. Features more typical for abscess in this case include the T2 hypointense rim, central pattern of diffusion restriction, and possible “daughter” or satellite lesions.[2, 3] CT scanning showed the infratemporal portion of the mass to be adjacent to the previously seen sphenoid sinus erosion (Fig 3), suggesting the erosion as a mechanism for extrasinus spread of disease. The patient underwent right temporal craniotomy and intracranial abscess drainage. Initial potassium hydroxide preparation demonstrated septate fungal hyphae, and aspergillus fumigatus was isolated from fungal cultures.