FIG 7.

Typical SBO with atypical organisms. A 75-year-old man with diabetes presented with left-ear discharge, conductive hearing loss, and headache. Initial imaging suggested an infiltrative neoplasm of the nasopharynx, and multiple endoscopic biopsies of the nasopharynx were performed to exclude nasopharyngeal carcinoma. Ultimately, biopsies of the external auditory canal revealed an infectious organism, Aspergillus species. The patient was treated with amphotericin with gradual resolution of symptoms. A, Axial enhanced CT image through the level of the nasopharynx suggests an infiltrative soft-tissue abnormality involving the submucosa and preclival soft tissues of the nasopharynx (arrow). B, Axial T1-weighted MR image through the nasopharynx shows poorly defined infiltrative soft tissue (arrowhead) in the submucosa of the nasopharynx on the left, extending to involve the left carotid space. There is also replacement of normal marrow on the left side of the basiocciput (arrow). C, Axial enhanced fat-saturated T1 image through the nasopharynx demonstrates abnormal enhancement on the left side of the occipital bone (arrow) as well as abnormal enhancing infiltrative tissue (arrowheads) in the preclival soft-tissue left carotid space and left retromandibular region. Courtesy of Dr Christine Glastonbury, Professor of Clinical Radiology, Otolaryngology Head and Neck Surgery, and Radiation Oncology, University of California, San Francisco, California.