Cholesterol granuloma and aspergilloma of the maxillary sinus

Cholesterol granuloma (CG) of the paranasal sinuses is rare. The proposed mechanisms of initiation are haemorrhage, impaired drainage and obstruction of ventilation. To the best of our knowledge, association of CG with a specific infection has not been described before. We have recently observed CG and aspergilloma of Aspergillus flavus type from the left maxillary sinus of a 58-year-old male patient presenting with nasal obstruction, headache and postnasal discharge. Any causative relationship between the two findings is obscure. The suspected mechanisms underlying aspergilloma and CG of the paranasal sinuses seems similar, since there is obstruction of ventilation and drainage. The cholesterol accumulation cannot be attributed to cellular components or breakdown products of the aspergillus as the major sterol of the plasma membranes of fungi is ergosterol, not cholesterol.