Allergic Fungal Sinusitis

These images demonstrate serpiginous centrally hyperdense material completely opacifying the right maxillary sinus, right ethmoid air cells, and portions of the right nasal cavity. There is associated osteitis of the posterior right maxillary sinus wall and erosions of the right ethmoid air cells. There is less involvement of the left maxillary sinus and left ethmoid air cells where post-surgical changes are noted. Findings are compatible with allergic fungal sinusitis. This is thought to occur as a result of an allergic response in immunocompetent patients to aerosolized fungi and hyperdense areas do not represent fungus itself. Usually multiple sinuses are involved with central hyperdense material and osseous erosions. Treatment may include surgical excision and steroid therapy.