临床误诊误治2025，Vol.38Issue(20)：23-27,5.DOI:10.3969/j.issn.1002-3429.2025.20.004
蝶窦非侵袭性真菌性鼻窦炎八例误诊分析及防范措施
Analysis of misdiagnosis and preventive measures of eight patients with non-invasive fungal sinusitis involving the sphenoid sinus
摘要
Abstract
Objective To investigate the clinical characteristics,laboratory tests,and imaging findings of patients with non-invasive fungal sinusitis(NIFS)involving the sphenoid sinus,to analyze the causes of misdiagnosis,and to propose preventive measures.Methods The case data of 8 patients with NIFS involving the sphenoid sinus admitted from January 2021 to December 2024 were collected and analyzed.Results Among the 8 patients,1 patient was misdiagnosed with chronic pharyngitis due to purulent discharge from the right nasal cavity and foreign body sensation in the throat for 2 months,one patient was mistakenly identified with a nasopharyngeal tumor due to blood in sputum for 6 months,one patient was diagnosed with ordinary nosebleeds due to repeated massive nosebleeds for 12 months,two patients were misdiagnosed with ordinary sinusitis due to symptoms such as nasal congestion and runny nose for one or three months,two patients were misdiagnosed with common sinusitis with intracranial infection due to severe headache and neurological symptoms,and one patient was misdiagnosed with a sphenoid sinus mass due to the accidental discovery of abnormal imaging in the sphenoid sinus area during a physical examination for one week without obvious clinical symptoms.During the nasal endoscopic sinus opening surgery,a gray brown or dark green brittle mass was found inside the sphenoid sinus.Postoperative pathological examination confirmed the diagnosis of sphenoid sinus NIFS involving the sphenoid sinus mainly composed of Aspergillus.The misdiagnosis period was from one week to twelve months.After surgery,the patient received 2 weeks of antibiotic treatment,combined with either Eucalyptus,Limonene,and Pinene Enteric soft capsules or Standard Myrtol capsules,as well as nasal sprays such as Mometasone Furoate,Fluticasone,or Budesonide.At 15 d after surgery,0.9%sodium chloride injection was used to flush the nasal cavity.At 3-month follow-up,all patients'symptoms completely disappeared,and the opening of the sphenoid sinus on the affected side was well opened,with good epithelialization of the sinus mucosa.Conclusion The clinical manifestations of NIFS in the sphenoid sinus are non-specific and the imaging findings are atypical,which can easily be confused with other diseases and lead to misdiagnosis.For patients with unexplained headaches,unilateral nasal congestion,or abnormal sinus imaging findings,routine sinus CT examination and necessary allergen and pathological examinations should be performed to reduce misdiagnosis.关键词
真菌性鼻窦炎/蝶窦/误诊/慢性咽喉炎/鼻咽肿瘤/鼻窦炎/影像学特征Key words
fungal sinusitis/sphenoid sinus/misdiagnosis/chronic pharyngitis/nasopharyngeal tumors/nasosinusitis/imaging features引用本文复制引用
李雪丽,郭任重..蝶窦非侵袭性真菌性鼻窦炎八例误诊分析及防范措施[J].临床误诊误治,2025,38(20):23-27,5.基金项目
湖南省自然科学基金资助项目(2025JJ80585) （2025JJ80585）
湖南省卫生健康委科研计划项目(B202307016508) （B202307016508）
2022年南华大学附属长沙中心医院科研立项项目(YNKY202233) （YNKY202233）
