Fungal colonization of the maxillary sinus occasionally manifests as a fungus ball. This clinical entity is, on occasion, referred to as mycetoma; however, this is an inappropriate term, because mycetoma refers to a locally destructive subcutaneous fungal infection that can involve muscle and bone. A maxillary sinus fungal ball, on the other hand, is not invasive. It is typically unilateral, may or may not be symptomatic, and occurs in an immunocompetent host. MR imaging may demonstrate heterogenous opacification with hypointense signal on T2-weighted images. CT imaging may reveal calcification centers within the fungal concretion (Fig. 1). Surgical exploration of the involved sinus reveals thick, mucinous, or clay-like concretions. This form of fungal infection usually has a benign course, and endoscopic sinus surgery is the treatment of choice. It is important to recognize that patients who become immunosuppressed are at risk for progression to invasive disease; therefore, expedient removal is recommended (3). Steroids are not necessary and there is no role for antifungal therapy.
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