The clinical and radiographic findings of 24 patients with aspergillosis of the maxillary sinus treated, from 1989 through 2004 were compared with those of 30 patients with non-fungal maxillary sinusitis to clarify factors related to differential diagnosis. The subjects with aspergillosis were 9 men and 15 women aged 26 to 78 years (mean, 52 years). The patients with non-fungal sinusitis were 25 men and 5 women aged 23 to 73 years (mean, 46 years). The most common clinical finding at presentation was cheek pain, followed by nasal symptoms in the aspergillosis group. Nasal symptoms were more common in the non-fungal group than in the aspergillosis group. Thus, pain was more often associated with aspergillosis. Radiographically, diffuse radiopacity was observed in the maxillary sinus of all patients in both groups. In addition, dense antral radiopacities indicative of calcification were seen in a patient with aspergillosis. On X-ray-CT scans, bone thickening of antral walls (23 cases), sand-like high density areas (20 cases), extension of soft tissue masses to the nasal cavity (17 cases), foamy low density areas (13 cases), and bone destruction (6 cases) were seen in the aspergillosis group. These findings were rarely seen in the non-fungal group. All patients in both groups were treated by radical surgery of the maxillary sinus. The postoperative course was uncomplicated, and there was no recurrence as of 1 year postoperatively.
In conclusion, the presence of pain, bone thickening of antral walls, sand-like high density areas, extension of soft tissue masses to the nasal cavity, foamy low density areas, and bone destruction on X-ray-CT scans were valuable for diagnosing aspergillosis of the maxillary sinus.
