The Algorithmic Role of Critical Radiographic Features in the Treatment of Angioinvasive Fungal Sinusitis.

IF 1.2 4区 医学 Q3 OPHTHALMOLOGY
Alexis Kassotis, Allison Coombs, Nahill Matari, Angela Lignelli, Michael Kazim
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引用次数: 0

Abstract

Introduction: Angioinvasive fungal sinusitis (AIFS) is a rapidly progressive, highly morbid infection. It can be challenging to obtain an early diagnosis, but intervention in the acute period is crucial for prognosis. Previous literature has identified numerous radiographic features with high sensitivity and specificity for AIFS, even in early disease. Bedside nasal endoscopy can substantiate the diagnosis but can also yield false negative results. Initially, these patients may present to the ophthalmologist. Thus, to avoid visual and potentially life-threatening complications, subtle clinical signs in conjunction with suspicious radiographic features must be promptly recognized by the ophthalmologist and escalated appropriately. We review, for the benefit of the ophthalmic community, the salient radiographic features of AIFS and integrate them into a decision-making algorithm for diagnostic workup and management.

Methods: A literature search was conducted using a comprehensive keyword search in the Pubmed and Embase databases. English studies from 1988 to 2022 describing the radiographic features of AIFS queried. Literature on the newly described entity, COVID-19 COVID-19-associated mucormycosis was included. The authors collected the most frequently reported indicators of AIFS.

Results: The authors review 4 radiographic findings that are frequently associated with AIFS, including in the early stages of disease: 1) loss of contrast enhancement in the nasal turbinate and maxilla (i.e., "black turbinate and maxillary sign"), (2) periantral involvement seen as changes in density, fat stranding or obliteration of the anterior, retromaxillary, or retroantral fat planes on CT, (3) Tissue invasion without bony erosion, (4) Hypointense T2W sinonasal secretions on MRI in the setting of acute sinusitis. The authors additionally propose an algorithm that suggests surgical exploration for patients with clinical concern for AIFS and these radiographic features, even if bedside nasal endoscopy is inconsistent with AIFS.

Conclusion: The radiographic signs highlighted herein should heighten suspicion for AIFS in the appropriate clinical setting, prompting urgent surgical exploration regardless of nasal endoscopy findings.

关键影像学特征在血管侵袭性真菌性鼻窦炎治疗中的算法作用》(The Algorithmic Role of Critical Radiographic Features in the Treatment of Angioinvasive Fungal Sinusitis)。
简介血管侵袭性真菌性鼻窦炎(AIFS)是一种进展迅速、发病率极高的感染。早期诊断具有挑战性,但在急性期进行干预对预后至关重要。以往的文献已发现许多放射学特征对 AIFS 具有高度敏感性和特异性,即使在疾病早期也是如此。床旁鼻内窥镜检查可确诊,但也可能出现假阴性结果。最初,这些患者可能会去看眼科医生。因此,为了避免视觉并发症和潜在的生命危险,眼科医生必须及时发现细微的临床症状和可疑的影像学特征,并进行适当的升级。为了眼科界的利益,我们回顾了 AIFS 的突出放射学特征,并将其纳入诊断工作和管理的决策算法中:方法:在 Pubmed 和 Embase 数据库中使用综合关键词进行文献检索。方法:在 Pubmed 和 Embase 数据库中使用综合关键词进行了文献检索,查询了 1988 年至 2022 年描述 AIFS 影像学特征的英文研究。还包括新描述的实体--COVID-19 COVID-19相关粘液瘤病的文献。作者收集了最常报道的AIFS指标:结果:作者回顾了与 AIFS(包括在疾病的早期阶段)经常相关的 4 个放射学发现:1)鼻甲和上颌骨造影剂增强消失(即 "黑色鼻甲和上颌骨征");(2)CT 表现为密度变化、脂肪绞窄或前方、腋后或腋后脂肪平面阻塞的窦周受累;(3)无骨侵蚀的组织侵犯;(4)急性鼻窦炎时 MRI 表现为低密度 T2W 窦分泌物。此外,作者还提出了一种算法,建议临床关注 AIFS 并具有这些放射学特征的患者进行手术探查,即使床旁鼻内镜检查与 AIFS 不一致:结论:本文强调的放射学征象应在适当的临床环境中提高对 AIFS 的怀疑,无论鼻内镜检查结果如何,都应立即进行手术探查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.50
自引率
10.00%
发文量
322
审稿时长
3-8 weeks
期刊介绍: Ophthalmic Plastic and Reconstructive Surgery features original articles and reviews on topics such as ptosis, eyelid reconstruction, orbital diagnosis and surgery, lacrimal problems, and eyelid malposition. Update reports on diagnostic techniques, surgical equipment and instrumentation, and medical therapies are included, as well as detailed analyses of recent research findings and their clinical applications.
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