The radiographic findings of AFS are characterized by multiple sinus involvement with the maxillary and ethmoids most frequent. Both polypoid disease and mucocele may be present. Bone erosion and bony deformities are common. Allergic mucin is characterized by a poorly staining mucoid background in which there are eosinophils in various stages of degradation, sloughed epithelial cells, and Charcot-Leyden crystals. The mucosa demonstrates polypoid changes.
Fungal elements are infrequent.
The diagnosis of AFS is confirmed by fungal culture. Although originally attributed to Aspergillus sp., it is becoming increasingly recognized that AFS is due to a family of fungi named dematiacious. Special culture techniques are required to isolate dematiacious fungi, underscoring the importance of communication with the pathologist. The optimal therapy for AFS has yet to be determined as there are no prospective series. AFS is diagnosed on the basis of histologic findings following surgical debridement.