Association of Cholesterol Granuloma and Aspergillosis in the Sphenoid Sinus

Abstract

Cholesterol granuloma (CG) is usually associated with chronic middle ear disease, and is not common in the paranasal sinuses. Additionally, it is very rare for cases of CG to be associated with a fungal infection. However, in this paper, we report a case of sphenoid sinus CG that is associated with aspergilloma in a 78-year-old male patient who presented with right hemifacial pain, headache and toothache. CT revealed the presence of an expansile cystic mass lesion in the sphenoid sinus that showed a high signal intensity on both the T1 and T2 weighted images. This mass was later determined to be CG. The suspected etiologic mechanisms of both CG and aspergilloma of the paranasal sinuses are similar, and impaired drainage and obstruction of the ventilation of the paranasal sinuses are considered to be the causative mechanism of both diseases. Overall, the results of this study indicate that the use of MRI findings could be helpful for differentiating CG from other paranasal sinus mass lesions.

RadIologIcal aspect of fungus ball wIthIn a mucocele of the sphenoId sInus

“…Cholesterol granulomas are seen with high signal intensity on both T1-and T2-weighted MRI images, related to the paramagnetic effect of methaemoglobin and granulations (11). Although mucoceles with high concentrations of protein may appear similar to cholesterol granulomas on…”

Fungus ball within a mucocele of the sphenoid sinus and infratemporal fossa: case report with radiological findings

“…5 Although mucoceles with high concentrations of protein may appear similar to cholesterol granulomas on T1-weighted MRI images, mucoceles have a lower signal intensity on T2-weighted scans, compared with cholesterol granulomas. Similarly to our case, the association of cholesterol granulomas and aspergilloma within the maxillary sinus has been reported.…”

“…Similarly to our case, the association of cholesterol granulomas and aspergilloma within the maxillary sinus has been reported. 5,6 Cystic schwannomas involving the sphenoid sinus are very rare. 7 Depending on the degree of cystic degeneration, cystic schwannomas show variable enhancement on contrast-enhanced CT and MRI scans.…”

Cholesterol granuloma of the sphenoid sinus: An unusual sphenoid sinus lesion

“…[1] Barring a very few small series, majority of the published primary spinal cord GBMs are isolated case reports. [2,3] Although GBM is the most common primary brain neoplasm in adults and makes up almost 50% of all astrocytic tumors, they are exceptionally rare in the spinal cord, amounting to only 3% of all intramedullary tumors. [1] The relatively low proportion of absolute number of neuroglial cells (as compared to brain) in the spinal cord probably accounts for the rarity of these neoplasms in the spinal cord.…”

“…CG of the sphenoid sinus has rarely been reported. [1][2][3] Symptoms of CG are usually related to the pressure effect on the adjacent structures. Rarely, CG of the sphenoid sinus can present with gradual loss of vision.…”