Computed tomographic features of feline sino-nasal and sino-orbital aspergillosis

Abstract

Feline upper respiratory tract aspergillosis (URTA) occurs as two distinct anatomic forms, sinonasal aspergillosis (SNA) and sino-orbital aspergillosis (SOA). An emerging pathogen, Aspergillus felis is frequently involved. The pathogenesis of URTA, in particular, the relationship between the infecting isolate and outcome, is poorly understood. Computed tomography was used to investigate the route of fungal infection and extension in 16 cases (SNA n=7, SOA n=9) where the infecting isolate had been identified by molecular testing. All cases had nasal cavity involvement except one cat with SNA that had unilateral frontal sinus changes. A strong association between the infecting species and anatomic form was identified. A. fumigatus infections remained within the sino-nasal cavity. Cryptic species infections were associated with orbital and paranasal soft-tissue involvement and with orbital lysis. These species were further associated with a mass in the nasal cavity, paranasal sinuses or nasopharynx. Orbital masses showed heterogeneous contrast enhancement, with central coalescing hypoattenuating foci and peripheral rim enhancement. Severe, cavitated turbinate lysis, typical of canine SNA, was present only in cats with SNA. These findings support that the nasal cavity is the portal of entry for fungal spores in feline URTA and that the route of extension to involve the orbit is via direct naso-orbital communication from bone lysis. Additionally, a pathogenic role for A. wyomingensis and a sinolith in a cat with A. udagawae infection are reported for the first time. Keywords: Aspergillus felis; Aspergillosis; Cats; Sino-nasal; Sino-orbital