I would like to respond to Dr Manning's letter elaborating on his reasons why the case presented could also be allergic fungal sinusitis as opposed to a mucocele. Although Dr Manning makes a compelling argument in his letter, we believe that this case with the photographs as presented does not support the diagnosis of allergic fungal sinusitis.
Allergic fungal sinusitis is extremely hypointense on all MR sequences. It appears signal void on T2 and extremely low signal on T1. The image in the article is a sagittal T1 image and demonstrates the contents of the lesion to be isointense to gray matter. We believe that this is too much signal to be consistent with allergic fungal sinusitis.
Spencer WR, Shawl MW, Reisacher WR, Zeifer BA. Diagnosis of Allergic Fungal Sinusitis vs a Mucocele. Arch Otolaryngol Head Neck Surg. 1999;125(10):1169. doi:
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