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Imaging Patterns of Rhino-Orbital-Cerebral Mucormycosis in Immunocompromised Patients

When to Suspect Complicated Mucormycosis

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Abstract

Purpose

The aim of this study was to describe radiological imaging findings of a complicated sinusitis, which should raise the suspicion of rhino-orbital-cerebral mucormycosis as being the underlying cause.

Methods

In this retrospective analysis, we describe the cases and imaging findings of 8 patients with proven mucormycosis. These patients presented mostly with new facial or orbital swelling and were referred for imaging to our institution. Magnetic resonance imaging and computed tomography images were classified as abnormal or normal with respect to orbital, paranasal and cerebral signal results. Special emphasis was placed on the distribution of the signal abnormalities regarding involvement of the skull base and the cavernous sinus.

Results

Out of a pool of 43 patients with colonization or proven Mucorales infection at different sites of the body, we identified 8 patients with infiltration of the midface and skull base. Unexpectedly seven out of the eight patients with abnormal findings of the paranasal sinuses and the adjacent tissues showed no bony sinus wall destruction. Of the eight patients seven showed inflammatory changes involving the infratemporal fossa and facial/periorbital tissues, three of the eight patients suffered from fungal invasion of the cavernous sinus and the carotid artery and one of the eight patients had a local infection of the hard palate only.

Conclusion

Imaging findings of inflammatory tissue infiltration adjacent to the paranasal sinuses with possible extension into the pterygopalatine fossa, infratemporal fossa and orbit or the cavernous sinus should raise the suspicion of a mucormycosis, especially in immunocompromised patients.

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Author information

Authors and Affiliations

  1. Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Peter Raab & H. Lanfermann

  2. Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Ludwig Sedlacek

  3. Praxis Dr. Buchholz, Goslarsche Str. 14, 38304, Wolfenbüttel, Germany

    Stefanie Buchholz

  4. Department of ENT, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Stefan Stolle

Authors
  1. Peter Raab
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  2. Ludwig Sedlacek
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  3. Stefanie Buchholz
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  4. Stefan Stolle
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  5. H. Lanfermann
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Corresponding author

Correspondence to Peter Raab.

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Conflict of interest

P. Raab, L. Sedlacek, S. Buchholz, S. Stolle and H. Lanfermann declare that they have no competing interests.

Ethical standards

All procedures described in this manuscript were carried out in accordance with national law and the Helsinki Declaration from 1964 (in its present revised form). This retrospective analysis was approved by the local ethics committee and the patients consented to the scientific anonymized use of their medical data.

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Raab, P., Sedlacek, L., Buchholz, S. et al. Imaging Patterns of Rhino-Orbital-Cerebral Mucormycosis in Immunocompromised Patients. Clin Neuroradiol 27, 469–475 (2017). https://doi.org/10.1007/s00062-017-0629-1

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  • DOI: https://doi.org/10.1007/s00062-017-0629-1

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