Black turbinate sign: a potential predictor of mucormycosis in cavernous sinus thrombophlebitis

Nunes, Douglas Mendes; Rocha, Antônio José da; Júnior, Marcos Rosa; Silva, Carlos Jorge da

doi:10.1590/s0004-282x2012000100019

Cited by 6 publications

(6 citation statements)

References 2 publications

(1 reference statement)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Common observations in our benign BT cases of thin rim enhancement around the nonenhancing areas (Figs 3 and 4) and intermediate and high signal intensity on the T2-weighted images were not consistently described in the cases of IFRS reported in the literature [1][2][3][4]7 or seen in our case of IFRS. Choi et al 4 stated that in patients with IFRS, "Although LoCE (Lack of Contrast Enhancement) showed variable signal intensity (SI), homogeneously or heterogeneously enhancing lesions showed exclusively low SI (100%, 12/12) on T2WI."…”

Section: Discussionsupporting

confidence: 41%

“…However, this comparison is itself limited by the relative rarity of cases of true pathologic turbinate NE both in the literature [1][2][3][4][5][6][7] and in daily practice.…”

Section: Discussionmentioning

confidence: 99%

“…L ack of enhancement of a nasal turbinate on MR images (the "black turbinate [BT] sign") has been reported as highly suggestive of invasive fungal rhinosinusitis (IFRS) in immunocompromised patients (Fig 1). [1][2][3][4][5] However, we have noticed nonenhancing (NE) turbinates in patients imaged for other indications, who have essentially no possibility of having IFRS. IFRS in the at-risk population is a rapidly progressive disease that frequently progresses to involve the orbit and brain.…”

mentioning

confidence: 95%

See 2 more Smart Citations

The Black Turbinate Sign, A Potential Diagnostic Pitfall: Evaluation of the Normal Enhancement Patterns of the Nasal Turbinates

Han¹,

Escott

2019

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: Lack of enhancement of a nasal turbinate on MR imaging, known as the black turbinate, has been reported as a finding highly suggestive of invasive fungal rhinosinusitis in immunocompromised patients. Our purpose was to investigate the normal enhancement pattern of nasal turbinates and to determine whether a black turbinate occurs in patients without invasive fungal rhinosinusitis and, if so, to distinguish differentiating features from pathologic enhancement. MATERIALS AND METHODS: We examined patient medical records and available MR imaging, which included most nasal turbinates in more than 1 sequence. Imaging was performed with contrast, either with or without fat saturation, in patients without invasive fungal rhinosinusitis. All MR images were evaluated for a turbinate enhancement pattern and the presence of nonenhancing areas. RESULTS: After we applied the exclusion criteria, 75 MR images from each group, with and without fat saturation, were included. Overall, the frequency of observed nonenhancing portions of turbinates, ie, black turbinates, was 30%. Most observed black turbinates were located in the posterior portion of inferior turbinates. Tiny areas of nonenhancement within turbinates were also a common finding. CONCLUSIONS: A black turbinate is not uncommon on MR images in immunocompetent patients who have no chance of having invasive fungal rhinosinusitis. Benign turbinate nonenhancement improves over subsequent series, has preserved thin peripheral enhancement, and often has thin internal septa. Knowledge of this normal pattern of nasal turbinate enhancement can aid in the differentiation of the benign black turbinate in immunocompetent patients from the pathologic black turbinate seen in patients with invasive fungal rhinosinusitis. ABBREVIATIONS: BT ϭ black turbinate; IFRS ϭ invasive fungal rhinosinusitis; NE ϭ nonenhancing or nonenhancement

show abstract

Section: Discussionsupporting

confidence: 41%

“…However, this comparison is itself limited by the relative rarity of cases of true pathologic turbinate NE both in the literature [1][2][3][4][5][6][7] and in daily practice.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 95%

See 1 more Smart Citation

The Black Turbinate Sign, A Potential Diagnostic Pitfall: Evaluation of the Normal Enhancement Patterns of the Nasal Turbinates

Han¹,

Escott

2019

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

“…Mientras que la RM cerebral es más sensible para demostrar afectación de los vasos (carótida, seno cavernoso) o parénquima cerebral. Además, de manera reciente se ha descrito en resonancia el denominado 'signo del cornete negro', que se considera un signo precoz de isquemia y que consiste en una ausencia de realce con el contraste paramagnético en los cornetes nasales 16,17 . Este signo, además de encontrarse en las fases iniciales, permite establecer un diagnóstico diferencial con otras causas más banales de sinusitis, como las bacterianas, en las cuales no se produce un realce ni una alteración de la intensidad de la mucosa nasal 17 .…”

Section: Discussionunclassified

Trombosis de seno cavernoso causada por zigomicosis invasiva fulminante: A propósito de un caso

León

López-García

Hernández-González

2015

Rev. chil. neuro-psiquiatr.

View full text Add to dashboard Cite

Zygomycosis is an opportunistic fungal infection caused by fungi of the Mucorales order. It's potentially lethal infection which generally affects diabetic or inmunocomprised patients. Cavernous sinus thrombosis is uncommon complication. We report the case of a 67 year old woman with invasive zycomycosis who present cranial nerves dysfunction (III, IV, VI, V1 and V2 branches of the trigeminal nerve), proptosis and retroorbital pain as initial manifestation. Brain magnetic resonance imaging evidence early indirect signs. Biopsy of the cavernous sinus revealed Rhizopus as the offending agent. A high index of suspicion is needed to correctly diagnose this condition for its optimal management.

show abstract

“…5 This black eschar appears on MRI as contiguous foci of nonenhancing tissue, so-called ''black turbinate sign,'' which presents in early stages in nasal mucormycosis and can aid in earlier detection. 3,6 So, recognition of this unusual finding may lead to the early diagnosis and subsequently prompt treatment of this rare but deadly disease. 3 On the basis of the important points described above, physicians should keep in mind that invasive nasal mucormycosis can be suspected when the inferior turbinate appears black upon endoscopic examination of the nasal cavity or when black turbinate sign is found on MRI.…”

mentioning

confidence: 99%

The Significance of “Black Turbinate Sign” on MRI

et al. 2019

View full text Add to dashboard Cite

A 65-year-old diabetic man was referred to our hospital with left facial numbness, headache, and malaise approximately 2 weeks' duration. Initially, his blood glucose level and HbA 1c level were measured at 592 mg/dL and 12.6%, respectively. With strict control of blood sugar, antibiotic therapy was started because of suspected bacterial sinusitis on initial brain magnetic resonance imaging (MRI). His symptoms seemed to improve, but the facial pain and headache were suddenly aggravated at 2 weeks of admission. He was consulted to our department. Endoscopic examination revealed the black eschar in the inferior turbinate (Figure 1). Rechecked MRI showed total lack of enhancement (black turbinate sign) of the inferior turbinate of left side on T1-weighted image (Figure 2). Under general anesthesia, the patient underwent endoscopic surgery with wide excision of the necrotic tissue. Histopathologic examination demonstrated angioinvasive hyphae with characteristics of mucormycosis (Figure 3). After surgery, he finished a 6-week course of amphotericin and he remained symptomfree 18 months later. Mucormycosis is an acute opportunistic, angioinvasive, and devastating fungal infection which is associated with high mortality rates. 1 There has been a significant increase in incidence over the last 2 decades. 2 Early and accurate diagnosis of invasive mucormycosis remains a challenge for physicians. However, patients with invasive mucormycosis initially present with nonspecific symptoms and signs, leading to delays in diagnosis and imaging modalities and cultures are not usually useful for diagnosis. 2-4 Mucor organisms have the propensity of angioinvasive hyphae that results in

show abstract

Black turbinate sign: a potential predictor of mucormycosis in cavernous sinus thrombophlebitis

Cited by 6 publications

References 2 publications

The Black Turbinate Sign, A Potential Diagnostic Pitfall: Evaluation of the Normal Enhancement Patterns of the Nasal Turbinates

The Black Turbinate Sign, A Potential Diagnostic Pitfall: Evaluation of the Normal Enhancement Patterns of the Nasal Turbinates

Trombosis de seno cavernoso causada por zigomicosis invasiva fulminante: A propósito de un caso

The Significance of “Black Turbinate Sign” on MRI

Contact Info

Product

Resources

About