CT shows complete unilateral maxillary-sinus opacification with internal calcific foci and medial-wall bowing. The patient is immunocompetent and has chronic unilateral symptoms. What is the best next step?
Unilateral disease requires exclusion of neoplasm and may represent a fungal ball. Endoscopic clearance restores drainage and provides tissue; systemic antifungal therapy is not routinely required for a non-invasive fungal ball.
A. Treat as bilateral inflammatory CRS without tissue diagnosis: Unilateral complete opacification has a broader differential and should not be assumed inflammatory.
B. Begin prolonged systemic antifungal treatment alone: Non-invasive fungal ball is principally treated surgically, while invasive disease requires a different urgent pathway.
C. Observe indefinitely because the patient is immunocompetent: Immunocompetence reduces invasive risk but does not exclude fungal ball or tumour.
D. Endoscopic assessment and surgical clearance with histopathology and microbiology: Unilateral disease requires exclusion of neoplasm and may represent a fungal ball. Endoscopic clearance restores drainage and provides tissue; systemic antifungal therapy is not routinely required for a non-invasive fungal ball.
E. Perform radical maxillectomy without biopsy: A destructive oncological operation is unjustified without diagnosis.
If imaging showed extrasinus invasion in an immunocompromised patient, urgent biopsy, debridement and systemic antifungal treatment for invasive fungal rhinosinusitis would be required.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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