Question: A consult is placed for a 79 year old patient with unilateral maxillary sinus opacification discovered on CT imaging obtained for a fall. The patient has a history of well-controlled diabetes with most recent Hgb A1c of 6.9%. The patient noted longstanding unilateral nasal obstruction and denied numbness, pain, or ocular symptoms. CT demonstrates bone erosion of the posterior and lateral walls of the maxillary sinus without suggestion of an expansile mass. Endoscopic examination is unremarkable with the exception of some mucosal edema and mucoid drainage from the right maxillary sinus. The patient is taken for endoscopic maxillary antrostomy. Frozen section histopathology shows submucosal invasion of fungal elements with rare angioinvasion. What is the most likely diagnosis?

a) Acute invasive fungal sinusitis

b) Chronic invasive fungal sinusitis

c) Fungal ball

d) Allergic fungal sinusitis

[Answer will be posted with next week's new question]

Answer to last week's question, “The ‘Wet Willy’" (March 9, 2020)

D - Malleus fracture.