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Imaging of Chronic and Exotic Sinonasal Disease: Review

¹ Department of Radiology, David Grant Medical Center, Travis Air Force Base, Fairfield, CA.
² Department of Radiology, Mayo Clinic College of Medicine, 5777 E Mayo Blvd., Phoenix, AZ 85054.
³ Department of Radiology, University of Washington, Seattle, WA.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —39-year-old woman with headache. Coronal unenhanced CT scan shows normal sinus anatomy, including each maxillary ostium (arrows), uncinate process (arrowheads), ethmoid bulla (B), middle nasal turbinate (M), inferior nasal turbinate (I), and infraorbital ethmoid cells or Haller cells (asterisks). Maxillary ostium enters infundibulum, which is space between uncinate process and ethmoid bulla.

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —59-year-old woman with headache. Noncontiguous axial unenhanced CT images show normal paranasal sinus anatomy. At level of mid globe, ethmoid (E) and sphenoid (S) sinus are visible, as well as middle crania fossa (M) and lamina papyracea (LP). At level of mid face, maxillary (M) sinuses have adjacent nasolacrimal duct (NLD), turbinates (T), pterygopalatine fossa (PtPF), infratemporal fossa (ITF), and nasopharynx (NP).

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —59-year-old woman with headache. Noncontiguous axial unenhanced CT images show normal paranasal sinus anatomy. At level of mid globe, ethmoid (E) and sphenoid (S) sinus are visible, as well as middle crania fossa (M) and lamina papyracea (LP). At level of mid face, maxillary (M) sinuses have adjacent nasolacrimal duct (NLD), turbinates (T), pterygopalatine fossa (PtPF), infratemporal fossa (ITF), and nasopharynx (NP).

View larger version (78K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Anterior drawing of ostiomeatal complex. Arrows show direction of mucociliary clearance. Potential areas of obstruction are denoted with X. Location of anterior ethmoid artery (A) is important in endoscopic sinus surgery. Graphic modified with permission from Mayo Foundation for Education and Research.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —80-year-old woman with chronic sinusitis. Unenhanced coronal CT scan shows extensive chronic thickening and sclerosis of maxillary sinus walls (arrows) and mucosal thickening causing near-complete opacification of sinuses. Intrasinus anatomy is distorted from prior bilateral antrostomies and ethmoidectomies.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —64-year-old man with history of sinus disease. Coronal T1-weighted MR image shows normal low signal of bone. Orbital lamina and floor (arrows, medial and inferior, respectively) and lateral maxillary wall (arrowhead) appear as normal low-signal linear structures, accentuated by adjacent high-signal fat. Soft tissue surrounding infundibulum (asterisk) is well delineated, as are middle (M) and inferior (I) turbinates.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —74-year-old man with diabetes and sinus infection caused by Aspergillus species. Calcifications (arrows) are centrally located in maxillary sinus. Abnormal soft tissue extends through medial wall of maxillary sinus and enters left side of nasal cavity (arrowheads).

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7 —23-year-old woman with history of multiple episodes of acute sinusitis. Smoothly marginated, peripherally located calcification (arrow) is typical of nonfungal disease.

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —19-year-old man with juvenile nasopharyngeal angiofibroma who presented with epistaxis. Coronal reformatted CT (A), unenhanced T1-weighted MR (B), and noncontiguous enhanced T1-weighted MR (C) images show large heterogeneously enhancing mass (arrows) in posterior nasopharynx that involves sphenoid sinus, pterygoid process, pterygopalatine fossa, and middle cranial fossa.

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —19-year-old man with juvenile nasopharyngeal angiofibroma who presented with epistaxis. Coronal reformatted CT (A), unenhanced T1-weighted MR (B), and noncontiguous enhanced T1-weighted MR (C) images show large heterogeneously enhancing mass (arrows) in posterior nasopharynx that involves sphenoid sinus, pterygoid process, pterygopalatine fossa, and middle cranial fossa.

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8C —19-year-old man with juvenile nasopharyngeal angiofibroma who presented with epistaxis. Coronal reformatted CT (A), unenhanced T1-weighted MR (B), and noncontiguous enhanced T1-weighted MR (C) images show large heterogeneously enhancing mass (arrows) in posterior nasopharynx that involves sphenoid sinus, pterygoid process, pterygopalatine fossa, and middle cranial fossa.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —19-year-old man with juvenile nasopharyngeal angiofibroma who presented with epistaxis. Early (A) and late (B) anteroposterior arterial phase right internal maxillary artery (IMA) injection angiograms before embolization show marked vascularity of juvenile nasopharyngeal angiofibroma (arrow).

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —19-year-old man with juvenile nasopharyngeal angiofibroma who presented with epistaxis. Early (A) and late (B) anteroposterior arterial phase right internal maxillary artery (IMA) injection angiograms before embolization show marked vascularity of juvenile nasopharyngeal angiofibroma (arrow).

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9C —19-year-old man with juvenile nasopharyngeal angiofibroma who presented with epistaxis. Early arterial phase right IMA angiogram after embolization shows marked reduction of vascularity (arrowhead).

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10 —50-year-old man with intractable nasal congestion. Coronal CT scan of paranasal sinuses shows complete opacification of right maxillary sinus and abnormal soft tissue extending through infundibulum on right into right nasal cavity (arrows). CT appearance is nonspecific and could represent polyposis or inverted papilloma. Middle meatal antrostomy has been performed on left (asterisk).

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11A —45-year-old-man with inverted papilloma. Coronal T1-weighted MR image shows mass (arrow) in posterior nasopharynx with signal intensity similar to that of muscle.

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11B —45-year-old-man with inverted papilloma. Coronal T1-weighted gadolinium-enhanced MR image highlights mildly enhancing mass (arrow), surrounded by more intensely enhancing mucosa.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12 —65-year-old-man with chondrosarcoma of nasal septum. Coronal CT scan of sinuses shows mass with irregular calcification destroying central portion of nasal septum (arrows).

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13 —61-year-old-man with chondrosarcoma of sphenoid sinus. Enhanced axial CT scan shows irregularly enhancing mass in sinus (black arrows). Intracranial extension is seen along right cavernous sinus (arrowhead) and right cerebellopontine angle (white arrow).

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