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case_images: CT of the head and orbits with IV contrast demonstrating soft tissue thickening and indistinctness of fat in the region of the right optic canal and right orbital apex and an unusual bone defect in the right lateral wall of the right sphenoidal sinus.
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case_images: Computerized tomography of the head and orbits demonstrated soft tissue thickening and indistinctness of fat in the region of the right optic canal and right orbital apex, possibly representing extension of paranasal inflammatory disease to an unusual bone defect in the right lateral wall of the right sphenoidal sinus (Fig. 1).
case_images: MRI of the brain, coronal view postcontrast T1 fat-suppressed CUBE, demonstrating phlegmonous extension of the right paranasal sinus infection into the orbital apex and toward the right cavernous sinus.
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case_images: Magnetic resonance imaging (MRI) of the brain without and with intravenous (IV) contrast showed right-sided paranasal sinus infection with transsphenoidal phlegmonous extension into the right orbital apex and cavernous sinus consistent with orbital apex syndrome (Fig. 2, Fig. 3).
case_images: Right orbital apex tissue showing extensive necrosis and chronic inflammation (hematoxylin and eosin, 200x original magnification). A focus of faintly-staining, basophilic (purple-staining) invasive hyphae can be observed at the inferior portion of the tissue in this image (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).
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case_images: The pathology revealed fungal hyphae consistent with Aspergillus spp. and related molds, with tissue invasion in the orbital apex (Fig. 4, Fig. 5).