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Coronavirus disease 2019 (COVID-19) is associated with a systemic inflammatory response that activates coagulation in symptomatic patients. In addition, a rare form of thrombosis has been reported in people who received the COVID-19 vaccine, most of whom were women younger than 50 years of age. Considering that hormonal contraceptive methods widely used by women of childbearing age increase the risk of thrombosis, the development of guidelines for the use of hormonal contraceptives in the era of the COVID-19 pandemic is necessary. In this context, the Korean Society of Contraception and Reproductive Health provides guidelines for issues regarding contraception and reproductive health during the pandemic.

Primary hepatic mixed germ cell tumor (GCT) is very rare, and less than 10 cases have been reported. We report a case of mixed GCT composed of a choriocarcinoma and yolk sac tumor, which occurred in the liver of a 40-year-old woman. A large mass was detected by computed tomography solely in the liver. Serum β-human chorionic gonadotropin (hCG) was highly elevated, otherwise, other serum tumor markers were slightly elevated or within normal limits. For hepatic choriocarcinoma, neoadjuvant chemotherapy was administered, followed by right lobectomy. Histologic features of the resected tumor revealed characteristic choriocarcinoma features with diffuse positivity for hCG in the syncytiotrophoblasts and diffuse positivity for α-fetoprotein and Sal-like protein 4 in the yolk sac tumor components. Primary malignant GCT in the liver is associated with a poor prognosis and requires specific treatment. Therefore, GCT should be considered during a differential diagnosis of a rapidly growing mass in the liver.

Background and Objectives The olfactory fossa is an important anatomical structure to prevent surgical complications such as skull base injury and meningitis. The purpose of this study is to determine if there is a difference in lateral lamella length (LLL) between the left and right sides, a topic that has been studied rarely in Korea. Subjects and Method We analyzed 592 left and right sides of 296 PNS CTs. We measured LLL as the distance between the fovea ethmoidalis and the horizontal cribriform plate in the olfactory fossa of the coronal surface where the crista galli was observed. Results The average LLL on the left side was significantly longer than that on the right. Age and LLL showed a negative correlation. Multiple regression analysis revealed younger age and left side as independent variables for predicting increasing LLL. Conclusion There was a significant difference between the two sides of LLL on sinus CT in Koreans. Before sinus surgery, the asymmetry of the ethmoid roof must be assessed, even by skilled doctors. If the height of the ethmoid roof is asymmetric, extra care is required during sinus surgery.

Purpose: Newly developed factor Xa inhibitor anticoagulants (Xaban) produced non-inferior outcomes in terms of venous thromboembolism (VTE) recurrence and safety. On the other hand, thrombus resolution (TR), a factor associated with VTE recurrence and post-thrombotic syndrome, was not expressed clearly in these studies. This study compared the long-term TR outcomes in patients treated with Xaban or warfarin. Methods : : Fifty-seven acute deep vein thrombosis (DVT) patients were enrolled. After the initial heparin therapy, randomly assigned patients received oral Xaban or warfarin. The time in the therapeutic range was maintained at more than 60% during the anticoagulation period. After 3–12 months on the medication, a duplex scan was performed to diagnose the thrombus changes. Results : : Unprovoked DVT occurred in 80.7% of patients (46/57), and the mean age was 60.1 ± 13.99 years; 26 patients were female. Concurrent pulmonary embolism was diagnosed in 20 patients (52.6%) in the Xaban group and 10 (52.6%) in the warfarin group. The complete TR rate for the proximal venous segment was 47.4% (18/38) for the Xaban group and 57.9% (11/19) for the warfarin group. Complete DVT TR was observed in 26.3% of patients (10/38) in the Xaban group and 42.1% (8/19) in the warfarin group. No significant difference was observed between the proximal (P = 0.657) and complete TR rates (P = 0.227) between the two groups. Conclusion : : Xaban administration for acute DVT showed no difference in TR compared to warfarin. Xaban could also be an easy-to-use anticoagulation treatment option because it does not require monitoring and has a short half-life.

Papillary fibroelastomas are the second most common primary cardiac tumor in adults. Over 80% of fibroelastomas occur on the cardiac valves, usually on the left side of the heart, while the remaining lesions are typically scattered throughout the atria and ventricles. Although the optimal timing for surgery is controversial and depends on tumor size and location, prompt surgical resection is warranted in patients at high risk of embolism. A tumor on the cardiac valve can be removed using the slicing excision technique without leaflet injury. Here we present two cases of papillary fibroelastomas occurring on the ventricular surface of the aortic valve and in the right ventricle.

Background Although lymph node metastasis is a poor prognostic factor in patients with pancreatic ductal adenocarcinoma (PDAC), our understanding of lymph node size in association with PDAC is limited. Increased nodal size in preoperative imaging has been used to detect node metastasis. We evaluated whether lymph node size can be used as a surrogate preoperative marker of lymph node metastasis. Methods We assessed nodal size and compared it to the nodal metastatic status of 200 patients with surgically resected PDAC. The size of all lymph nodes and metastatic nodal foci were measured along the long and short axis, and the relationships between nodal size and metastatic status were compared at six cutoff points. Results A total of 4,525 lymph nodes were examined, 9.1% of which were metastatic. The mean size of the metastatic nodes (long axis, 6.9±5.0 mm; short axis, 4.3±3.1 mm) was significantly larger than that of the non-metastatic nodes (long axis, 5.0±4.0 mm; short axis, 3.0±2.0 mm; all p

Purpose: The correlation of initial anatomy of the aneurysm, aneurysmal remodeling and endoleaks is controversial. We performed a retrospective study to measure aneurysmal remodeling with time, and to assess the structural changes in the aneurysm neck after endovascular aneurysm repair (EVAR). Materials and Methods : : From January 2013 to February 2018, 108 patients with abdominal aortic aneurysms (AAA) underwent EVAR. Follow-up computed tomography images were available for 90 patients. Anatomic variables, including the neck angle, neck length, maximal diameter, maximal area, and thrombus volume were measured. Temporal changes were measured preoperatively, immediate postoperatively (within 1 week after EVAR), and at 6 months, 1 year, and 2 years post-EVAR. Correlation between the variables according to the temporal changes and presence of type Ia endoleaks (T1aE) was analyzed. Results : : The mean follow-up period was 10.63±20.34 months. Significant decreases in neck angle and length occurred immediately postoperative (P

Background Reports of metastatic sarcoma to the pancreas are limited. We reviewed the clinicopathologic characteristics of such cases. Methods We reviewed 124 cases of metastatic tumors to the pancreas diagnosed at Asan Medical Center between 2000 and 2017. Results Metastatic tumors to the pancreas consisted of 111 carcinomas (89.5%), 12 sarcomas (9.6%), and one melanoma (0.8%). Primary sarcoma sites were bone (n=4); brain, lung, and soft tissue (n=2 for each); and the uterus and pulmonary vein (n=1 for each). Pathologically, the 12 sarcomas comprised 2 World Health Organization grade III solitary fibrous tumors/hemangiopericytomas, and one case each of synovial sarcoma, malignant solitary fibrous tumor, undifferentiated pleomorphic sarcoma, osteosarcoma, mesenchymal chondrosarcoma, intimal sarcoma, myxofibrosarcoma, myxoid liposarcoma, rhabdomyosarcoma, subtype uncertain, and high-grade spindle-cell sarcoma of uncertain type. The median interval between primary cancer diagnosis and pancreatic metastasis was 28.5 months. One case manifested as a solitary pancreatic osteosarcoma metastasis 15 months prior to detection of osteosarcoma in the femur and was initially misdiagnosed as sarcomatoid carcinoma of the pancreas. Conclusions The metastatic sarcoma should remain a differential diagnosis when spindle-cell malignancy is found in the pancreas, even for solitary lesions or in patients without prior history.

First trimester surgical abortion is an effective and safe procedure. Although its failure is uncommon, congenital uterine anomaly may be considered as one of the etiologic factors in such cases. Here, we report a rare case of surgical abortion failure that was successfully managed by operative hysteroscopy-assisted dilatation and evacuation (D&E) under ultrasound guidance in a woman with complete uterine septum. The patient was referred to Severance Hospital after two consecutive surgical abortion failures even under ultrasound guidance. A missed abortion in a left-sided hemicavity of septate uterus was noted on ultrasonography. Ultrasound-guided D&E was unsuccessful because the curette could not reach the uterine cavity with the gestational sac. Operative hysteroscopy revealed insufficient communication with the left-sided cavity just above the cervical internal os of the uterine septum. After widening the communication, ultrasound-guided D&E was successfully performed.

A unicuspid aortic valve is a rare congenital malformation that frequently presents with valvular dysfunction and dilatation or aortic aneurysm, requiring combined aortic valve surgery and aortic repair. Some patients show severe valve calcification extending into the interventricular septum, possibly resulting in damage to the conduction system during debridement for valve replacement. We present a rare case of severe aortic stenosis with a unicommissural unicuspid aortic valve diagnosed by preoperative transesophageal echocardiog-raphy in a 36-year-old man. After composite graft replacement of the aortic valve, aortic root, and ascending aorta, a permanent pacemaker was placed because of postoperative complete heart block.

Purpose: There are several commercially approved stent grafts in Korea for the treatment of abdominal aortic aneurysms (AAAs). Each device has its advantages and disadvantages based on the patient’s anatomy and the clinical situation. The Zenith device allows accurate and precise endograft placement, whereas the Endurant device has improved flexibility and trackability. We reviewed 5 cases in which a combination of the Zenith main body and the Endurant iliac limb was used. Materials and Methods: From January 2010 to February 2015, 90 patients with AAA underwent endovascular aneurysm repair (EVAR) using the Zenith body at Daegu Catholic University Hospital. Among them, 5 patients who underwent EVAR with the Zenith body and Endurant iliac limb were included in this study. Results: The mean age of the patients was 74.20±3.35 years. All patients were men. The main reason for use of the Endurant iliac limb was aortoiliac angulation. Type III endoleak, stent migration, and stent kinking were not noted. Comparing 85 patients who received a Zenith endograft with 5 patients who received the hybrid endograft, there were no statistical differences in clinical characteristics, intraoperative details and post procedural complications. The mean admission duration was 19.00±13.60 days, and the mean follow-up duration was 1,018.11±925.34 days. In the hybrid endograft group, there was no mortality during the follow-up duration. Conclusion: Although the material, radial force, diameter, and length of the overlap zone differ between the two devices, EVAR with the hybrid endograft is safe and effective.

Background Pancreatic neuroendocrine tumors (PanNETs) are the second most common pancreatic neoplasms and there is no well-elucidated biomarker to stratify their detection and prognosis. Previous studies have reported that progesterone receptor (PR) expression status was associated with poorer survival in PanNET patients. Methods To validate previous studies, PR protein expression was assessed in 21 neuroendocrine microadenomas and 277 PanNETs and compared with clinicopathologic factors including patient survival. Results PR expression was gradually decreased from normal islets (49/49 cases, 100%) to neuroendocrine microadenoma (14/21, 66.6%) to PanNETs (60/277, 21.3%; p < .001). PanNETs with loss of PR expression were associated with increased tumor size (p < .001), World Health Organization grade (p = .001), pT classification (p < .001), perineural invasion (p = .028), lymph node metastasis (p = .004), activation of alternative lengthening of telomeres (p = .005), other peptide hormonal expression (p < .001) and ATRX/DAXX expression (p = .015). PanNET patients with loss of PR expression (5-year survival rate, 64.1%) had significantly poorer recurrence-free survival outcomes than those with intact PR expression (90%) by univariate (p = .012) but not multivariate analyses. Similarly, PanNET patients with PR expression loss (5-year survival rate, 76%) had significantly poorer overall survival by univariate (p = .015) but not multivariate analyses. Conclusions Loss of PR expression was noted in neuroendocrine microadenomas and was observed in the majority of PanNETs. This was associated with increased grade, tumor size, and advanced pT and pN classification; and was correlated with decreased patient survival time by univariate but not multivariate analyses. Loss of PR expression can provide additional information on shorter disease-free survival in PanNET patients.

Purpose: Cone shape neck is regarded as non-instruction for use (IFU) in most commercial stent graft. However, in real practice, liberal application of endovascular aneurysm repair (EVAR) for outside of IFU happens. We investigate non-adherence to conical neck anatomy in terms of early aneurysmal exclusion results. Materials and Methods: From January 2010 to December 2013, 105 patients with abdominal aortic aneurysm (AAA) underwent EVAR in Daegu Catholic University Medical Center. Among them, 38 patients (36.2%) had AAA with conical neck. We investigated the clinical characteristics of patients and the details of conical neck. We also analyzed the clinical results, such as endoleak, migration, procedure failure, perioperative mortality, and admission duration between conical neck and non-conical neck. Results: The maximum diameter of AAA was larger (60.95 mm vs. 52.68 mm, P=0.016) and the infrarenal neck length was shorter (25.07 mm vs. 38.13 mm, P=0.000) in conical neck group. During the procedure, type Ia endoleak occurred more in conical neck group (23.7% vs. 6.0%, P=0.013) and it could be successfully solved with additional adjunctive treatments, such as balloon or Palmaz stent. Although there was no statistical significance, mortality was higher and admission duration was longer in the conical neck (15.8% vs. 6.0%, 16.62±13.12 days vs. 13.03±13.13 days). Mean follow-up duration was 319.2±366.45 days. Successful aneurysmal exclusion was achieved. Conclusion: The presence of conical neck may not be a contraindication for EVAR. However, conical neck requires careful observation for additional adjunctive treatments because it increases the risk of type Ia endoleak.

Background: In recent years, the demand for fertility preservation for both oncologic and nononcologic reasons, as well as for personal reasons, has increased dramatically. Current Concepts: Currently, embryo and oocyte cryopreservation after ovarian stimulation are the mainstays of fertility preservation treatment in women. Embryo cryopreservation is an established and the most successful method of fertility preservation when sufficient time (approximately 2 weeks) is available to perform ovarian stimulation. Recent advances in freezing techniques (vitrification) have significantly improved the outcomes from oocyte cryopreservation that are comparable with those from embryo cryopreservation. Discussion and Conclusion: This review focuses on the indications for the two techniques of fertility preservation and their results. For women to receive timely opportunities to preserve fertility, it is necessary to raise awareness among all medical departments and the public. [ABSTRACT FROM AUTHOR]

Background and Objectives: The present study evaluated the results of skin prick test using 55 allergens at 20 centers in the Republic of Korea in 2006, 2010, and 2014-2015. The aim was to assess changes in the positive rate of allergens according to temporal, regional, and environmental factors. Materials and Method: In total, 20 hospitals were selected based on the population distribution in the Republic of Korea. A skin prick test panel comprising 55 aeroallergens was distributed to 18 hospitals for this prospective study. The 2006 and 2010 skin prick test results were collected and analyzed retrospectively from 20 hospitals, while the 2014/2015 skin prick test results (from June 2014 to May 2015) were collected prospectively from 18 hospitals. Results: A total of 14,897 SPT test results were analyzed: 4,319 in 2006, 7,431 in 2010, and 1,852 in 2014/2015. The overall rate of skin prick test positivity to more than two allergens was significantly higher in males than females. The positive rates of alder pollens and birch, oak and ragweed pollen positivity were increased in older patients. Several positive rates were increased according to the temperature in spring. The positive rates for beech pollen, birch pollen, hazel pollen, oak pollen, Tyrophagus putrescentiae, mugwort, cat, Acarus siro, Lepidoglyphus destructor and Tyrophagus putrescentiae were significantly increased, while those of Cult rye pollen and dandelion were significantly decreased over the three test periods. The overall positive rate for allergens in Jeju province varied significantly from Seoul and other cities. Conclusion: Change in the positive rate of multiple aeroallergens was evaluated in the Republic of Korea over time. Our findings can be used to recommend aeroallergens suitable for inclusion in skin prick test panels in the Republic of Korea and will facilitate further investigation of changes in the patterns of allergic diseases. [ABSTRACT FROM AUTHOR]

Restoration of a patient with thin and low residual ridges using a removable partial denture cannot provide proper anterioposterior stability and support, so it results in patient discomfort and severe occlusal force. Also, when a small number of residual teeth are far apart from one another, it is difficult to splint. When these teeth are not splinted, they become solitary abutments, which is not a wise treatment decision. In this case, telescopic system reduces severe lateral load on abutments resulting from a clasp denture and it provides stable and definite retention and solidity. In this case report, a patient exhibited full edentulism in maxilla, and a small number of residual teeth in mandible, which were restored with a complete denture and a telescopic denture respectively. In treatment planning, it was concluded that a patient was restored with a telescopic denture since it was highly probable that a clasp denture would create discomfort and difficulty due to a small number of residual teeth located far apart and residual ridges without proper support. [ABSTRACT FROM AUTHOR]

Background and Objectives : Frontal sinus trephination requires understanding of frontal sinus anatomy. This study aims to identify frontal sinus depth (FSD) and bone thickness of its anterior table (FBT) using the axial images of paranasal computed tomography (CT) scans. Subjects and Methods : We obtained the axial images taken from 30 men and 30 women. FSD and FBT were estimated at points 5, 10, and 15 mm from the midline (the straight line passing through the crista galli) on each side using the axial CT images. Results : The mean male FSDs at 5, 10, and 15 mm from midline were 11.08 ± 1.92, 11.38 ± 2.08, and 11.49 ± 2.27 mm, respectively; mean female FSDs were 8.23 ± 1.38, 8.47 ± 1.65, and 8.87 ± 1.76 mm, respectively. Men had signifcantly larger FSDs than women did at all measurement points (p < 0.001). The mean male FBTs at 5, 10, and 15 mm from midline were 3.59 ± 1.11, 3.25 ± 0.93, and 3.65 ± 1.25, respectively; mean female FBTs were 3.25 ± 0.85, 3.11 ± 0.91, and 3.28 ± 0.87 mm, respectively. There were no significant differences between FBTs of men and women (p > 0.05). Conclusion : These data provide the information about the frontal sinus in Korean adults. [ABSTRACT FROM AUTHOR]

Proper management of provisional prosthesis is key to success in prosthodontics. Provisional restoration on maxillary anterior missing area frequently come across a incident of falling off especially in patients with long span pontics and oval arch shape. This is because maxillary anterior teeth are more exposed to horizontal force than the posterior teeth and additional anterior cantilever effect will negatively affect to the retention of provisional prosthesis. Beside that maxillary anterior provisional prosthesis should provide proper incisal guidance during the mandibular functional movements. However occlusal contacts on the prosthesis in maximum intercuspal position are located on opposite side of fulcrum line of prosthesis which will cause removing force against the provisional prosthesis. This case report present that provisional implant prevent pre-described harmful effect on maxillary anterior fixed provisional prosthesis and provide comfort and satisfactory result during post-extraction healing period. [ABSTRACT FROM AUTHOR]

PURPOSE This study aimed to validate the effect of core-based exercise on proprioception in individuals with neurological disorders through a systematic review and meta-analysis. METHODS A systematic literature search was conducted using databases such as PubMed, Web of Science, and Scopus for studies published up to October 10, 2023. The search yielded 1,945 articles, with seven studies ultimately included for in-depth analysis. Meta-analysis was performed using Review Manager 5.4 software. Standardized mean differences (SMDs) were calculated using Hedges’ g value using both random-effects and fixed-effects models. RESULTS The meta-analysis revealed that core-based exercise significantly improved joint position sense (SMD=-1.33; 95% confidence interval [CI]=-2.09 to −0.57; I²=0%; p

PURPOSE This study aimed to prove the mediator effect of skill level on participation frequency and injury level of leisure sports players with the highest injury rate. METHODS Raw data of the “2019 Sports Safety accident data” conducted by the Korea Sports Safety Foundation were used for this study. We analyzed 857 leisure sports players participating in events with the top four highest injury rates (Basketball, Soccer, Baseball/Softball, Foot Volleyball). Frequency, descriptive statistics, and correlation analyses using SPSS version 27.0 and Process macro model 4 were employed for analysis. RESULTS The results regarding participation frequency, injury severity, and skill level among recreational athletes are as follows. First, a positive correlation was established between the participation frequency of recreational athletes and their skill levels. Second, the correlation between participation frequency and injury severity was observed only in soccer and basketball. Third, skill level plays a mediating role in the relationship between participation frequency and injury level. The results indicate that as the participation frequency among leisure sports players who participate in ball sports with a high injury rate increases, this affects the degree of injury. CONCLUSIONS Skill level appears to play a mediating role in the relationship between participation frequency and injury level. Based on the results, we recommend safety education not only on the relationship between participation frequency and injury level, but also the intermediary role of skill level.

PURPOSE The first purpose of this study is to investigate the relationship between Post-Stroke Respiratory Sarcopenia (PSRS) and Cognitive Impairment (CI) through Breathing Exercise (BE) as a respiratory rehabilitation after stroke (ST). The second purpose is to introduce a pilot study design set to investigate and compare the acute effects of each BE to develop a BE protocol for further studies. METHODS Pubmed, Scopus, Web of Science and Google Scholar search engines were used to identify the definition and mechanism of ST, CI and respiratory sarcopenia (RS), and to find cases of application of BE in such conditions. RESULTS Review; BEs that improve ST, RS, and CI symptoms are Box Breathing (Tactical Breathing), Fast-Breathing, Slow-paced Breathing, Inspiratory Diaphragmatic Breathing+Expiratory Pursed-lip Breathing Exercise. However, the effect is still unclear as post-stroke patients undergo multiple medical treatments other than BE. Pilot Study Prospective results; Inspiratory Diaphragmatic Breathing+Expiratory Pursed-lip Breathing Exercise, Slow-paced Breathing, Box Breathing (Tactical Breathing) and Fast-Breathing will be performed by 40 healthy college students through a randomized controlled trial for 4 weeks. Respiratory functions, exercise intensity, active oxygen level, blood lactate level, cerebral oxygen saturation and cognitive function will be measured pre- and post-intervention along with acute and 2 week mid-intervention. BEs are expected to improve respiratory function, cognitive performance and energy levels while reducing HR, BP, and stress. However, individual response to BE may vary according to health, physical fitness and life styles. All BE will be conducted in an evenly controlled and supervised environment for accurate data collection. CONCLUSIONS Further study will be done to develop an appropriate BE protocol for PSRS patients per this review. Follow-up studies may also use this review as a reference for the application of BEs in PSRS patients with CI.

Objective This study aimed to evaluate the endometrial transcriptomic patterns in the early secretory phase (ESP) and mid-secretory phase (MSP) of the natural menstrual cycle before in vitro fertilization and embryo transfer (IVF-ET). Methods Thirty patients whose endometrial tissues were obtained from the ESP or MSP of a natural menstrual cycle immediately before IVF-ET were included. Endometrial dating was histologically confirmed as ESP (cycle days 16–18) or MSP (cycle days 19–21), according to the noyes criteria. The patients were divided into two groups depending on the IVF-ET outcome: pregnant (n=14; 7 in ESP and 7 in MSP) or non-pregnant (n=16; 8 in ESP and 8 in MSP). Differentially expressed genes (DEGs) in the MSP, compared to the ESP, were identified using NanoString nCounter (NanoString Technologies, Seattle, WA, USA) data for both the pregnant and non-pregnant groups. Results Thirteen DEGs in the pregnant group and 11 DEGs in the non-pregnant group were identified in the MSP compared to those in the ESP. In both groups, adrenoceptor alpha 2A, interleukin 1 receptor-associated kinase 2, a disintegrin and metalloproteinase with thrombospondin repeats 15 (ADAMTS15), serpin family E member 1, integrin subunit beta 3, transmembrane protein 252 (TMEM252), huntingtin associated protein 1, C2 calcium-dependent domain containing 4A, and integrin subunit alpha 2 were upregulated in the MSP, compared to the ESP. TMEM37, galactosidase beta 1 like 2, Rho family GTPase 3, and cytochrome P450 family 24 subfamily A member 1 were upregulated in the MSP only in the pregnant group. ADAMTS8 was downregulated and monoamine oxidase A was upregulated in the MSP only in the non-pregnant group. Conclusion Transcriptomic patterns in the endometrium immediately before IVF-ET appear to differ according to the IVF-ET outcome. These novel DEGs, which have not been previously studied, may have functional significance during the window of implantation and serve as potential biomarkers of endometrial receptivity.

Background and Objectives The purpose of this study was to classify radiological findings of patients diagnosed with maxillary sinus fungus ball and to analyze the differences in surgical approach methods and postoperative results. Methods As a retrospective study, we reviewed the medical records of 221 patients (unilateral in 216: bilateral in 5). Results On computed tomography (CT), 49% of the lesions had an irregular surface or a protruding part. There was a significant difference in surgical approach according to pneumatization of the maxillary sinus when middle meatal antrostomy (MMA) was performed alone or combined with MMA and inferior meatal antrostomy (IMA) (p=0.042). Extension of a maxillary sinus lesion caused by fungus ball was not associated with stenosis of the MMA (p=0.328). Conclusion Diagnosis of maxillary sinus fungus on CT was associated with irregular lesion surface or a protruding calcification. In patients with fungus ball of the maxillary sinus, the more severe is the maxillary sinus pneumatization, the larger is the extent of IMA needed.