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21-Year-Old Female with Chronic Nasal Congestion
This case features a 21-year-old female presenting with chronic nasal congestion, ultimately diagnosed with allergic fungal rhinosinusitis.
Imaging overview:
Coronal non-contrast CT in both bone and soft tissue windows, along with axial NECT in bone window, demonstrates expansile, remodeled sinuses with associated bony thinning and erosion. Diffuse opacification is present with a central, serpiginous hyperdense component, as indicated by the yellow arrows on the annotated images. No intraorbital or intracranial extension is identified in this case.
Clinical insight:
Allergic fungal rhinosinusitis is a chronic inflammatory process that occurs in immunocompetent patients — immune compromise is not a prerequisite and its absence should not exclude the diagnosis. Bilateral sinus involvement is more typical, though unilateral disease can occur. The characteristic central hyperdensity within opacified sinuses, representing inspissated fungal debris and proteinaceous material, is best appreciated on soft tissue windows and should be specifically evaluated when this diagnosis is suspected. Bony remodeling and expansion, rather than aggressive destruction, further supports the diagnosis.
Case courtesy of Jennifer Joyce, DO, Medical University of South Carolina.