The Trend of Changes in Paranasal CT Scan in Patients with Hematologic Malignancy Under Chemotherapy

The aim of this study was to evaluate the clinical significance of early screening of computerized tomography scan of paranasal sinuses (PNS CT) in hematologic malignancies before chemotherapy and evaluation of changes after chemotherapy and during neutropenia.

All 40 new cases of hematologic malignancies with febrile neutropenia in a teaching referral hospital between 2018 and 2019 were enrolled in this study. All of these patients underwent paranasal sinus (PNS) CT scan before chemotherapy, along with other preliminary investigations. Symptoms and signs indicating the infectious process were meticulously followed and monitored before and during chemotherapy as well as the occurrence of febrile neutropenia. All patients were clinically and radiologically evaluated regarding the presumptive diagnosis of invasive fungal sinusitis during prolonged febrile neutropenia (more than 4 days). PNS CTs before and after chemotherapy of all patients were compared by two radiologists and were evaluated based on histopathologic findings of nasal and or paranasal biopsies.

Around 50% of patients with PNS CT scan abnormality suspected inflammatory process including microbial and fungal sinusitis during prolonged febrile neutropenia (more than 4 days) were confirmed that have had similar involvement before starting chemotherapy and these abnormalities have been stable with no significant changes after chemotherapy. The histopathologic examination of sinuses also showed no evidence of invasive fungal infection by endoscopic biopsy. Therefore, the abnormal findings including mucosal thickening in PNS CT during prolonged febrile neutropenia were not consistent with the confirmed invasive fungal infection. The rate of mortality was 2.5% without association with invasive fungal sinusitis.

A considerable number of patients with underlying hematologic malignancies have paranasal sinus involvement such as mucosal thickening that may be misdiagnosed as invasive fungal sinusitis during the hazardous phase of prolonging febrile neutropenia. Thus, performing PNS CT scan before initiation of chemotherapy even though in asymptomatic patients could be helpful to decrease the number of suspected and probable cases of fungal sinusitis based on abnormal findings in PNS CT scan followed by the number of cases undergoing sinus endoscopic surgery.