Image features of aspergillosis arising from the pterygopalatine fossa: a case report and literature review

Aspergillosis of the skull base is an unusual disease entity, mainly found in immunocompromised patients. Aspergillosis originating in the pterygopalatine fossa (PPF) without contiguous spread from the sinuses is extremely rare. A 79-year-old woman complained of having suffered pain in her left cheek and headaches for 4 months. Computed tomography (CT) scans revealed soft tissue filling the left PPF with sclerotic change and erosion of the adjacent bone. A follow-up CT scan 1 month later after supportive care showed an increase in the extent of the soft tissue lesion in the left PPF with progressive erosion of the posterior wall of the left maxillary sinus. Magnetic resonance imaging revealed a low-signal-intensity mass in the PPF on T2-weighted images; the mass displayed strong enhancement on contrast-enhanced T1-weighted images and extended into the left maxillary sinus, infratemporal fossa, and cavernous sinus. The patient underwent a Caldwell-Luc operation with debridement of the PPF; the histopathological diagnosis was aspergillosis. The patient eventually died from cerebral ischemic change and brain edema during the postoperative period.