Unusual Location of a Fungus Ball: The Concha Bullosa, a Review of the Literature

Abstract

Introduction The fungal balls of the paranasal sinuses are usually seen in the maxillary and sphenoid sinuses. Although, the lesion of the concha bullosa, without sinus participation, is very uncommon. We report the case of a fungal ball of concha bullosa in an 88-year-old patient. Objective The objective of our review of literature is to investigate the epidemiological, clinical, paraclinical, and therapeutic characteristics of patients diagnosed with fungus ball in concha bullosa. Methods A case of a patient who was diagnosed with concha bullosa of a fungus ball is reported. Demographic data, clinical presentation, imaging, and treatments were recorded. Key images were obtained. A review of the literature was also performed. Results A total of 12 cases have been reported so far in the literature revealed by different symptoms. The mean age was 38.8 years and the gender ratio was ∼12 (female):1 (male). The endoscopic surgical approach was the most frequently used treatment and provides good outcomes. Neither postoperative complications nor recurrences were noted, however, there is insufficient follow-up data. Conclusion Concha bullosa fungal ball is a rare diagnosis that can be revealed by different symptoms. It should be considered in patients with and unexplained chronic facial pain. A preoperative computed tomography scan is an essential tool in making a diagnosis. Endoscopic surgery is the treatment of choice, with a low morbidity and recurrence rate.

Fungal ball in concha bullosa as incidentaloma: A case report and the review of the literature

“…To the best of our knowledge, there are only 17 cases of FB in CB described in literature, including 2 cases reported by DuFour, but without any clinical or radiological informations. [1 , 3 , 6 , 8 , 10 , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] ].…”

“…Clinical examination itself is often inconclusive, with no specific findings such as middle turbinate hypertrophy, and septal deviation, probably due to the CB mass effect on the nasal septum [8] .…”

“…In particular both the erosion of the inner sinus wall and the irregular surface of the material seem to have high specificity and positive predictive value (PPV) for FB diagnosis, mainly in patients without intralesional hyperdensity [8 , 27] . In addition, irregular surface of the material can help to differentiate FB from chronic unilateral rhinosinusitis [27] .…”

“…Magnetic Resonance Imaging (MRI) can also help to reach a diagnosis, but its long acquisition times, the high costs, as well as its lower availability limit its use in clinical practice. MRI is generally used as a second step, for assessment of complications such as bacterial superinfection, bacterial sinusitis, meningitis, and even brain empyema [8] . When MRI is performed, FB mass shows hyperintensity on T1-weighted images, and heterogeneous intensity on T2-weighted images, with central void signal.…”

“…The diagnosis of fungus ball involving concha bullosa was based on the imaging features described in literature [5] , [6] , [7] , [8] , [9] and the result of the rhino-endoscopic examination ( Fig. 3 ) [5 , 6] .…”