Resolution of invasive fungal sinusitis in two pediatric patients with acute lymphoblastic leukemia

Non-enhanced axial (A) and coronal (B) CT scan through the orbits demonstrates opacification of the maxillary and ethmoid sinuses bilaterally. Intrinsic high density within the thickened sinus mucosa and retained sinus secretions are characteristic for fungal infection. There is destruction of the left middle turbinate and extension of disease into the left lacrimal fossa with abscess formation and subperisoteal extension.

Coronal (A) and axial (B) T2 sequences of the sinuses demonstrate low T2 signal intensity characteristic of fungal infection within the bilateral ethmoid sinuses, with left lacrimal fossa abscess and subperiosteal extension. There is an associated enhancement on the postgadolinium T1 images.

Coronal (A) and axial (B) T2 sequences through the sinuses 8 months later demonstrate postsurgical changes of a right maxillary antrostomy. New soft tissue within the right maxillary sinus which is T2 hypointense and enhances on postgadolinium T1 coronal (C) and axial (D) sequences is characteristic for fungal sinus disease. This obstructs the right osteomeatal unit and extends into the right pterygopalatine foramen.