1. BY
Dr. J K PATIL ,
ASSOCIATE PROFESSOR OF RADIODIAGNOSIS,
D.Y.PATIL HOSPITAL AND RESEARCH CENTER.
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5. Coronal section showing anterior draining pathway including frontal recess
(white arrow), maxillary ostium (thin black arrow),infundibulum (thick black
arrow), middle meatus (short black arrow) and maxillary sinus (star).The
frontal recess affords mucociliary drainage of the frontal and anterior
ethmoidal sinuses into the middle meatus
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10. The superior “free” edge of the uncinate process may be (1) deviated medially to
obstruct the middle meatus, and (2) inclined laterally to compromise the
infundibulum. Coronal CT at the level of OMC showing uncinate process (black
arrow), agar nasi cells (short white arrow) and frontal recess(white long arrow)
11. Coronal CT image showing Haller cells which are infraethmoid air cells (white
arrows) along the roof of the maxillary sinus medially, causing narrowing of the
infundibulum (black arrow)
12. Coronal CT at the level of sphenoid sinus (asterix),showing Onodi cells lying
superior to the sphenoid sinuses and in close relation to optic nerves (black
arrows). onodi cells are lateral and posterior extensions of the posterior ethmoid
air cells. They extend close to the optic nerves as they exit the orbits
13. Ethmoid bulla (arrow) seen on the left side.
Prominent ethmoid bulla is the largest of the ethmoid air cells,and may
enlarge to narrow or obstruct the middle meatus and infundibulum
19. Waters view shows a left maxillary sinus air-f luid level
(arrow) with minimal mucosal thickening within the sinus. The
remaining
sinuses are normal. This patient had acute bacterial sinusitis
Axial CT scan shows a left maxillary sinus mucoid attenuation air-fluid
level with minimal mucosal thickening. The right maxillary sinus is
normal. Clinically this patient had acute bacterial sinusitis
20. Caldwell view shows soft-tissue clouding of both frontal sinuses and
in the right ethmoid sinuses. There is also a right frontal sinus air-
fluid level (arrow) in this patient with acute bacterial sinusitis
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23. Infundibular pattern: In this the disease is limited to maxillary sinus and
corresponding infundibulum and can occur due to mucosal thickening, polyp in
that location or Haller cells. Rest of the sinuses, are normal.
B. Ostiomeatal unit pattern: In this the obstruction is in the middle meatus
thus causing obstruction and changes in frontal sinus, anterior and middle
ethmoid sinus and maxillary sinus.Cause may be mucosal thickening, polyps,
concha bullosa,deviated septum or nasal tumor.
24. SPHENOETHMOIDAL RECESS PATTERN
In this the sphenoethmoid recess is blocked and changes seen only in
ipsilateral sphenoid and posterior ethmoid air cells.
A polyp in posterior ethmoid(black arrow)is causing partial obstruction of
spheno ethmoid recess causing sphenoid sinusitis(white arrow)
27. Mucocele of the ethmoid sinus. Plain X-ray Water’s view (A) shows an
expanded and opaque left ethmoid sinus. Coronal non-contrast CT (B) shows
the expanded sinus containing soft tissue densities. The wall of the sinus are
thickened but are intact
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31. Coronal CT scan shows mucosal thickening in the left maxillary sinus associated
with thickened, sclerotic bone in the sinus walls.there are areas of rarefaction and
early sequestrum formation along the upper antral wall. Minimal mucosal disease
is also present in the right maxillary sinus. This patient had chronic sinusitis with
osteomyelitis
32. RETENTION CYST
Waters view shows a solitary left
antral retention cyst or polyp
(arrows). This cyst typically has a
smooth, outwardly convex
contour. The remaining antrum
and the other sinuses are normal
33. Waters view shows a
retention cyst or polyp
(arrow) in the roof of the left
maxillary sinus. If there was
a history of recent orbital
trauma, this could be
mistaken for part of a blow-
out fracture. In this
patient,coronal sectional
images would have
demonstrated an intact
orbital floor.
34. MUCOCELE
Caldwell view shows clouding of the
right frontal and ethmoid sinuses.
There is thinning and downward
displacement of the right
superomedial orbital rim. This
patient has sinusitis and right frontal
sinus mucocele
35. Caldwell view shows a loss of the
normal left frontal sinus margin
scalloping (arrows) and portions of
the normal white mucoperiosteal line
around the sinus and in the roof of
the left orbit. This patient had a left
frontal sinus mucocele.
36. .
CHOLESTEATOMA
Caldwell view (A) shows a smoothly expansile lesion in the lateral right frontal
bone, which is thinning and depressing the right orbital roof. A thin white
mucoperiosteal line surrounds the mass. Coronal CT scan(B) shows the localized,
expansile, homogeneously ‘‘mucoid’’ attenuation mass, which is depressing the right
orbital roof.
40. Caldwell view shows a comminuted fracture of the
frontal bone (arrows) that extends into the frontal
sinus.
41. .
Lateral plain film (A) shows a depressed anterior frontal sinus wall fracture
(arrow). Lateral tomogram film (B) shows a depressed fracture (arrow) of the
anterior wall and floor of the frontal sinus
43. Epithelial tumors are further subdivided into two groups:
A. Tumors of epithelial origin
B. Tumors of salivary gland origin
Tumors of epithelial origin include:
• Papillomas
• Squamous cell carcinoma
• Adenocarcinoma
Tumors of salivary gland origin include:
• Pleomorphic adenoma
• Adenocystic carcinoma
• Acinic cell carcinoma
• Mucoepidermoid carcinoma
Amongst these the adenoid cystic carcinoma are the most frequent
tumors. This lesion typically causes destruction and remodelling of
bone.
Adenoid cystic carcinoma characteristically shows perineural and
intraneural spread.
44. Squamous cell carcinomas are the commonest epithelial neoplasms of the
paranasal sinuses. They constitute upto 63 percent of malignancies of this
region
Maxillary sinus (25-58%) is most commonly involved followed by ethmoid
(10%) andsphenoid and frontal sinuses (1%).
The nasal cavity is the site of origin in 25-35percent of cases. The industrial
workers involved in the production of nickel, chromium,isopropyl alcohol,
radium, mustard gas and wooden furniture areat an increased risk to develop
this malignancy.
Chronic sinusitisand polyposis may predispose to squamous cell carcinomas
probably believed to be related to the squamous cell metaplasia ofthe
respiratory mucosal lining of the sinuses.
Squamous cell carcinoma is twice as common in men than women and occurs
in
the 6th and 7th decade.
Unilateral facial pain and purulent nasaldischarge are the commonest
presenting features of sinonasalcarcinoma. Epistaxis and nasalobstruction are
other presentingsymptoms.
45. Caldwell view shows clouding of the right ethmoid and maxillary sinuses, with
destruction of the right lamina papyracea and a portion of the floor of the right orbit
Squamous cell carcinoma.
B, Waters view shows destruction of the lower lateral wall of the left maxillary sinu
(arrow)
46. Squamous cell carcinoma of the right maxillary sinus. Noncontrast CT scan shows sof
tissue mass of intermediate attenuation with central necrosis filling the right antrum.
The lesion extends beyond the bony walls of the sinus, bone window setting show
extensive lytic distruction of the walls.The hallmark of imaging malignancies of the
sinonasal cavity is bony destruction, seen in approximately 80 percent of scans of
sinonasal squamous cell carcinomas at initial presentation
47. Inverted papilloma of the right
antrum and ethmoids.
Noncontrast CT scan shows a
hyperdense soft tissue lesion in
the right ethmoid and nasal
cavity extending into the right
antrum. The middle turbinate is
destroyed and the septum shows
focal erosion. The floor and
medial wall of the orbit is eroded
at places
48. Staging classification for inverted papillomas was proposed by Krause
which was later modified by Cannady. The Modified Krause staging is:
A. Inverted papilloma (IP) confined to the nasal cavity, ethmoid sinus,
or medial maxillary wall.
B. Inverted papilloma (IP) with involvement of any maxillary wall
(other than the medial wall) or frontal sinus or sphenoid sinus
C. Inverted papilloma (IP) with extension beyond the paranasal
sinuses
The significance of the staging is that, Stage A lesions may
need only endoscopic resection while the more radical approaches
reserved for grade B or C lesions.
50. Angiofibroma lateral X-ray of skull showing anterior bowing (small arrow) of the
posterolateral wall of the maxillary sinus due to the angiofibroma (open arrow)
51. Angiofibroma is a benign, but locally invasive highly vascular,
nonencapsulated neoplasm of the PNS.
These tumors nearly always originate near the pterygopalatine fossa.
Patients are almost exclusively adolescent males between the ages of 10-20
years.
The tumor spreads into the maxillary, ethmoid and sphenoid sinus
and also into the infratemporal fossa and nasal cavity.
These are highly vascular tumors and are supplied from the internal
maxillary
and ascending pharyngeal arteries.
It can invade the orbit through the inferior orbital fissure or have an
intracranial extension via the superior orbital fissure, pterygoid canal and
foramen rotundum.
On plain X-rays the characteristic sign of anterior bowing of the posterolateral
wall of the maxillary sinus.
widening of the pterygopalatine fossa and soft tissue density filling the
nasopharynx and sphenoid sinus are pathognomonic of this lesion
52. (a) Axial CT shows a tumour that arises from the right pterygoid plate and grows
into and widens the pterygopalatine fossa (asterisk). The tumour then grows
anteriomedially through the sphenopalatine foramen (white arrow), laterally
through the pterygomaxillary fissure (black arrow), and posteriorly into the
Vidian canal (arrowheads). (b) Coronal CT demonstrates destruction of the
pterygoid plate just posterior to the pterygopalatine fossa.
53. FIBROUS
DYSPLASIA
Fibrous dysplasia is an idiopathic
skeletal disorder in which
medullary bone is replaced by a
dysplastic fibrosseous tissue
which is composed of woven type
of bone with few osteoclasts.
Fibrous dysplasia: Plain X-ray of
the skull PA view shows diffuse
areas of sclerosis the typical
ground glass appearance of the
expanded bones of the right side
of the face. Note the dimensions
of the right orbit are reduced
54. Caldwell view shows a mixed ‘‘lytic’’ and ‘‘blastic’’ expansile lesion in the left frontal
bone (arrows) that has depressed the superior orbital margin. This patient had fibrous
dysplasia
55. .
OSTEOMA
Caldwell view shows an ivory-type
osteoma in the base of the right frontal
sinus. The sinus is not obstructed
56. Caldwell view shows bilateral
frontal sinus osteomas. Note
that in this patient the
osteomas have remained
within the contour of the
frontal sinuses, and a thin rim
of air is seen outlining each
osteoma.
57. OSSIFYING FIBROMA
Waters view shows an expansile bony mass in the lateral wall of the right maxillary
sinus. The mass has displaced the lateral sinus wall toward the midline (arrows).
This patient had an ossifying fibroma 2)Axial CT scan shows a ‘‘ground glass’’ bony
mass projecting into the right maxillary sinus cavity. There is a surrounding cortex
