真菌性上顎洞炎の画像診断学的考察

抄録

In recent years, fungal sinusitis in not immunocompromised patients has been reported not so rarely as previously thought. As the disease is resistant to conservative treatment, it is important to distinguish the fungal sinusitis from chronic non-fungal ones or malignant diseases. In this paper, radiographic findings of six patients with fungal sinusitis were analysed and literature of this disease was reviewed. The relation between pathogenic mechanism and radiograhic findings was also discussed.
The six patients comprising five women and one man, ranged in age from 29 to 64 years, with a mean age of 45.3 years. Four of the six patients were thought to be associated with odontogenic lesions and/or inappropriate dental procedures (“odontogenic factor”). Radical surgery was carried out for all cases and the diagnosis of Aspergillosis was made by histological examinationin. The “fungus ball” and calcification in it was also proved on removed material.
Plain radiographs of all six patients showed the loss of radiolucency of unilateral maxillary sinus and/or other paranasal sinuses on the same side. In three of the four cases associated with an odontogenic factor, a foreign body was visualised in the maxillary sinus, one was a root tip and remaining ones were seemingly a fragments of dental paste spilled over from the upper first molar. Soft tissue shadow of a fungus ball was seen in one case.
Five of the six patients underwent computed tomography (CT). On CT of all five cases, a soft tissue density was visualised in the unilateral maxillary sinus and/or other paranasal sinuses on the same side, and the soft tissue bulged out toward the nasal cavity at the level of the middle nasal concha. A sand-like high density area, which was separated from sinus wall, was found in the soft tissue in four of the five cases.
Fungal sinusitis is thought to be aerogenic infection through the nasal pathways. The findings of disappearance or destruction of the medial wall of maxillary sinus and a soft tissue bulging toward nasal cavity seem to support this hypothesis. But, not a few cases have odontogenic factor, and fungal sinusitis always affects almost unilateral side of paranasal sinus as in odontogenic sinusitis. So, it is thought that the odontogenic factor is not a direct cause of infection but one of the causes of initiating and/or accelerating the clinical process of fungal sisunsitis.