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Dr Öretmenolu makes excellent points. Most patients do not have classic CT findings of bone erosion or extrasinus extension in the early course of invasive fungal sinusitis. Severe unilateral thickening of the nasal cavity mucosa is the most consistent finding on CT suggestive of underlying invasive fungal sinusitis in immunocompromised patients, but this is also a nonspecific finding and often represents other processes. The clinician cannot rely solely on CT imaging and must maintain a high index of suspicion when evaluating immunocompromised patients to establish a prompt diagnosis.¹

Angiofibroma, a disease of adolescent boys, arises from either the lateral wall or the roof of the nasopharynx.² Although angiofibromas commonly extend beyond the nasopharynx, in very rare instances they may arise outside the nasopharynx.³ Guo et al⁴ reported 7 cases of nasopharyngeal angiofibroma with extranasal and extrapharyngeal involvement.

Shahriar Nazari, MD
Zahedan

Vafa Rahimi-Movaghar, MD
Department of Neurosurgery
Khatam-ol-aniba Hospital
Zahedan 98157, Iran
(e-mail: v_rahimi@yahoo.com)

Seyed Abolhassan Jazayeri, MD
Zahedan

Berrylin J. Ferguson, MD
Pittsburgh, Pa

1. DelGaudio JM, Swain RE Jr, Kingdom TT, Muller S, Hudgins PA. Computed tomographic findings in patients with invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg. 2003;129:236-240. FREE FULL TEXT 2. Yadav SP, Singh I, Chanda R, Sachdeva OP. Nasopharyngeal angiofibroma. J Otolaryngol. 2002;31:346-350. PUBMED 3. Crespo del Hierro J, Gete Garcia P, Coello Casariego G, Rivas E, Monge Jodra R, Alvarez-Vicent JJ. Extra-naso-pharyngeal angiofibroma: report of a new case and review of literature [in Spanish]. Acta Otorrinolaringol Esp. 2002;53:297-301. PUBMED 4. Guo MH, Li YH, Huang YL. Resection of nasopharyngeal angiofibroma with extranasal and extrapharyngeal involvement. Di Yi Jun Yi Da Xue Xue Bao. 2002;22:572-573. PUBMED

Arch Otolaryngol Head Neck Surg. 2003;129:1351-1352.

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