Received: September 17, 2021 Accepted: September 20, 2021 Published: September 20, 2021
Background and objectives: The first case of the novel Covid -19 was reported from the Hubei province of China on 17th November 2019, and soon it became pandemic. It has impacted family life, reduced social harmony, distorted household income, disrupted the education of children, marginalized religious faith badly; however, it has promoted the capacity building for health crisis management. A Myriad of opportunistic infections has been encountered in patients with Covid-19 infection, related to the infection itself or its treatment cocktail. The study aims to demonstrate the usefulness of MRI to diagnose various important and rare imaging findings in rhino-orbito-cerebral mucormycosis.
Method: This is a descriptive observational study conducted at multiple centres over two months, involving all patients of Covid-19 who developed mucormycosis of the paranasal sinuses during the treatment and in the post-recovery phase.
Results: Total 108 patients with male preponderance presented with mucormycosis, all had an association with coronavirus disease 2019. Out of the total, 42% of patients presented with painful proptosis. The maxillary sinuses (97.22 %) were the most common sinuses affected. The intra-orbital extension was observed in 63 % of cases, while 10 %of cases had intracranial extension also. Three patients had perineural spread, and one patient developed a mycotic aneurysm of the posterior cerebral artery. All patients had a history of steroid administration during their Covid-19 pneumonitis treatment.
Conclusions: In the context of the use of immunosuppressants in the Covid-19 treatment protocol, MRI plays a very crucial role in the early diagnosis of rhino-orbito-cerebral mucormycosis. It typically shows an increased T2W signal in sinonasal mucosa. MRI is a highly sensitive tool for prompt diagnosis of mucormycosis-related complications and evaluates adjacent invasion of the disease such as orbital extension, cavernous sinus thrombosis, involvement of internal carotid artery, and brain invasion. The Diffusion-Weighted Images (DWI) adds precision in localizing the disease extension by eliciting restricted diffusion in the path of fungal invasion. Multiplanar MRI is of utmost importance in planning for surgical debridement and judicial use of antifungals to ascertain prognosis.
Keywords: Fungal, Sinusitis, MRI