48THE SINUSES

DAVID SUTTON

DAVID SUTTON PICTURES

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig. 48.1 SSCT showing the normal osteomeatal complex. Incidental able regarding the anatomy, anatomical variants and pathology. bilateral concha bullosa. The arrow points to the infundibulum and ostium.

• Fig. 48.2 (A, B) Plain X-ray. Note opacification due to acute sinusitis and the fluid levels on tilted view (B).

• Fig. 48.3 CT scan showing infection in the sinuses with orbital cellulitis and superior ophthalmic vein thrombosis (arrowhead).

• Fig. 48.4 Extensive nasal polyposis with pansinus opacification. The septa and sinus walls are thinned and eroded.

• Fig. 48.5 Frontoethmoid mucocele. (A) Direct coronal CT scan demonstrates expansion of the right ethmoid cells with bony expansion and a mass which extends into the right orbit. (B) Axial T,-weighted and (C) axial T2 -weighted MRI scans show expansion and scalloping of the bony margins with extension into the right orbit.

• Fig. 48.5 Frontoethmoid mucocele. (A) Direct coronal CT scan demonstrates expansion of the right ethmoid cells with bony expansion and a mass which extends into the right orbit. (B) Axial T,-weighted and (C) axial T2 -weighted MRI scans show expansion and scalloping of the bony margins with extension into the right orbit.

• Fig. 48.6 Axial T,-weighted gadolinium-enhanced MRI of a sphenoid mucocele demonstrates an expanded rim enhancing sphenoid sinus containing fluid-density material.

• Fig. 48.7 (A) Coronal CT scan showing diffuse and nodular calcification in the fungal mass in the sphenoid sinus. (B, C) Axial T2 and proton density MRI scans demonstrate signal void from the fungal mass. (D) Sagittal T,-weighted scan shows intermediate signal intensity material within the sphenoid sinus.

• Fig. 48.7 (A) Coronal CT scan showing diffuse and nodular calcification in the fungal mass in the sphenoid sinus. (B, C) Axial T2 and proton density MRI scans demonstrate signal void from the fungal mass. (D) Sagittal T,-weighted scan shows intermediate signal intensity material within the sphenoid sinus.

• Fig. 48.9 MRI scans and angiogram of nasopharyngeal angiofibroma. (A) Axial STIR-weighted MRI scan shows a predominantly high signal intensity mass within the posterior nose and extending into the nasopharynx. Areas of flow void are seen within this highly vascular mass. (B) Axial T 1 -weighted MRI scan demonstrates the intermediate signal intensity mass within extension into the pterygopalatine fossa (arrow). This shows intense enhancement following gadolinium (C). This is confirmed on the angiogram (D), which preceded embolisation of this nasopharyngeal angiofibroma.

Fig. 48.9 MRI scans and angiogram of nasopharyngeal angiofibroma. (A) Axial STIR-weighted MRI scan shows a predominantly high signal intensity mass within the posterior nose and extending into the nasopharynx. Areas of flow void are seen within this highly vascular mass. (B) Axial T 1 -weighted MRI scan demonstrates the intermediate signal intensity mass within extension into the pterygopalatine fossa (arrow). This shows intense enhancement following gadolinium (C). This is confirmed on the angiogram (D), which preceded embolisation of this nasopharyngeal angiofibroma.

• Fig. 48.10 (A) Orthopantomogram (OPG). There is abnormal bony texture and destruction of the right side of the maxilla. (B) OPG shows bony destruction of the right side of the maxilla with an abnormal opacity within the right maxillary antrum. This was due to a squamous cell carcinoma with adjacent bone invasion. (C) Occipitomental (OM) view demonstrates an opacity of the right maxillary antrum with destruction of the lateral wall of the maxillary antrum. An abnormal opacity is also seen within the nasal cavity.

• Fig. 48.10 (A) Orthopantomogram (OPG). There is abnormal bony texture and destruction of the right side of the maxilla. (B) OPG shows bony destruction of the right side of the maxilla with an abnormal opacity within the right maxillary antrum. This was due to a squamous cell carcinoma with adjacent bone invasion. (C) Occipitomental (OM) view demonstrates an opacity of the right maxillary antrum with destruction of the lateral wall of the maxillary antrum. An abnormal opacity is also seen within the nasal cavity.

• Fig. 48.11 (A) Direct coronal scan on bone window settings demonstrates a large abnormal soft-tissue mass (squamous cell carcinoma) extending from the right maxillary antrum, destroying the inferior orbital wall and extending into the orbital fat on the right side, with destruction of the medial orbital floor and lateral maxillary antral floor, and abnormal soft tissue is seen within the ethmoid air cells and within the soft tissues of the cheek. (B) Large soft tissue mass (squamous cell carcinoma) based upon the left maxillary antrum. It has involved and destroyed the floor of the maxillary antrum, with destruction of the maxilla and the lateral maxillary antral wall and spread of soft tissue into the cheek and the floor of the orbit. There is extension into the orbital fat, through into the medial maxillary antral wall and the nasal cavity.

• Fig. 48.12 Axial CT scans displayed on soft tissue (A) and bone (B) window settings show a large soft-tissue mass involving the right maxillary antrum. There is destruction of the posterolateral wall of the right maxillary antrum and abnormal soft tissue is seen extending into the infratemporal fossa and right pterygopalatine fossa (arrow). Note the normal-appearing left pterygopalatine fossa (arrowhead).

Fig. 48.13 Soft-tissue mass (squamous cell carcinoma) involving the right maxillary antrum. There is destruction of the posterolateral maxillary antral wall, where abnormal soft-tissue is seen extending into the fat of the right infratemporal fossa (arrow). Note normal low-attenuation fat in the left infratemporal fossa (arrowhead).

• Fig. 48.14 (A, B) Axial contrast-enhanced CT scans of an extensive ethmoid carcinoma showing abnormality extending up through the cribriform plate and involving the inferior aspect of the frontal lobes bilaterally (B).

• Fig. 48.15 T,-weighted fat-saturated scan after intravenous gadolinium enhancement in the coronal plane in a patient with a maxillary antral carcinoma demonstrates an enhancing mass seen within the mesostructure and infrastructure of the right maxillary antrum, with abnormality involving the right maxilla and soft tissues of the cheek. Note that the suprastructure of the right maxillary antrum is not involved, with a normal-appearing right orbit and orbital floor.

• Fig. 48.16 (A) T,-weighted axial MRI scan of a patient with a maxillary antral carcinoma before gadolinium enhancement. (B) Axial T,-weighted fat-saturated scan in the same position after gadolinium enhancement. Both scans demonstrate a large mass, which shows enhancement following intravenous gadolinium, filling the right maxillary antrum and extending posteriorly into the infratemporal fossa on the right (arrow).

• Fig. 48.17 Axial (A), coronal (B) and sagittal scans (C) of a patient with a recurrent adenoid cystic carcinoma of minor salivary gland origin. There is abnormal enhancing soft tissue extending superiorly through the foramen lacerum (arrow in C) and filling the right cavernous sinus (arrowheads in A and B).

• Fig. 48.17 Axial (A), coronal (B) and sagittal scans (C) of a patient with a recurrent adenoid cystic carcinoma of minor salivary gland origin. There is abnormal enhancing soft tissue extending superiorly through the foramen lacerum (arrow in C) and filling the right cavernous sinus (arrowheads in A and B).