Most patients do not have classic CT findings of bone erosion or extrasinus extension in the early course of IFS. We found that severe unilateral thickening of the nasal cavity mucosa was the most consistent finding on CT suggestive of underlying IFS, occurring much more frequently in immunocompromised patients with IFS than without IFS. Even though severe nasal cavity soft tissue thickening is much more common in IFS, this is a nonspecific finding that can be seen, to a lesser degree, in all forms of rhinosinusitis. Therefore, the clinician cannot rely solely on CT imaging and must maintain a high index of suspicion when evaluating immunocompromised patients to establish a prompt diagnosis. Early nasal endoscopy with biopsy and initiation of appropriate therapy are necessary to improve prognosis.

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Since allergic fungal sinusitis was initially described by Millar in 1981, many have tried to define and explain the disorder. It has been labeled as the sinonasal equivalent of allergic bronchopulmonary aspergillosis; however, allergic fungal sinusitis cannot be categorized so easily. According to the literature at this time, there are five major criteria and six associated characteristics or minor criteria of patients with allergic fungal sinusitis. In reality, patients may not develop all five major criteria or have any of the associated criteria for years. Allergic fungal sinusitis is not only difficult to diagnose, but it is one of the most complicated conditions rhinologists must manage. Endoscopic sinus surgery must be used in conjunction with long-term medical therapy, oral and nasal corticosteroids, immunotherapy, antifungal therapy, and antimicrobial agents to effectively control the problem. Allergic fungal sinusitis is most likely the endpoint in a spectrum of sinonasal disease, driven by the presence of fungus and eosinophils with their inflammatory mediators. The affected nasal mucosa no longer functions properly, and a cycle of chronic edema, stasis, and bacterial superinfection results. Therapy entails disrupting the inflammatory process to allow normal mucosal function to resume.

Extracranial meningiomas are rare tumors, comprising approximately 2% of all meningiomas. Previously reported sites include the orbit, parapharyngeal space, and rarely, the paranasal sinuses. A retrospective chart review of patients with meningiomas was performed over the last 25 years, and three patients were identified with meningiomas involving the paranasal sinuses. The locations included the frontal sinus, the ethmoid sinus, and the sphenoid sinus. Presenting symptoms included facial pain and nasal obstruction; two patients noted facial swelling. Diagnosis was established via endoscopic transnasal biopsy in two patients. Computed tomographic (CT) guided biopsy was utilized to confirm the diagnosis in the third patient. Surgical extirpation was successfully performed with tumors arising from the ethmoid and frontal sinuses. The patient with neoplasm in the sphenoid sinus underwent radiation therapy. Extracranial meningiomas of the paranasal sinuses are rare tumors that may present a diagnostic and therapeutic challenge. We present three cases and discuss the clinical presentation, radiographic findings, diagnostic evaluation, and treatment options.

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