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Images in Neurology
December 2010

Sphenoid Sinus Fungus Ball With Skull Base Erosion

Author Affiliations

Author Affiliations: Departments of Neurosurgery (Dr Gallia) and Otolaryngology (Dr Ishii), Johns Hopkins Hospital, Baltimore, Maryland.

Arch Neurol. 2010;67(12):1528-1529. doi:10.1001/archneurol.2010.296

An 85-year-old woman with a history of polymyalgia rheumatica was evaluated for recurrent sinusitis at Johns Hopkins Hospital, Baltimore, Maryland. She had a several-year history of headaches secondary to sinus disease that responded well to medical therapy. The patient had undergone computed tomography of the head 4 years previously that demonstrated opacification and expansion of the left sphenoid sinus (Figure 1A). Over time, her symptoms increased in frequency and were less responsive to medical therapy. Because of her worsening symptoms, she again underwent computed tomography, which demonstrated opacification of the left sphenoid sinus, with high-density central contents and expansion of the walls. Compared with her previous computed tomographic scans, there was now significant erosion of the skull base (Figure 1B). Magnetic resonance imaging demonstrated an expansile lesion in the left sphenoid sinus that was centrally T1-weighted hyperintense and T2-weighted hypointense and isointense without significant enhancement (Figure 1C and D).