paranasal sinus inflammation

1. PNS INFLAMMATORY
CONDITIONS

2. • Acute sinusitis is an acute inflammation of the paranasal sinus mucosa that
lasts less than four weeks and can occur in any of the paranasal sinuses. If
the nasal cavity mucosa is also involved - rhinitis - then the
term rhinosinusitis may be used.

3. Radiographic features
• Imaging findings of acute sinusitis are non-specific and can be seen in a large
number of asymptomatic patients (up to 40%) . Imaging findings should be
interpreted with clinical and/or endoscopic findings.
• A gas-fluid level is the most typical imaging finding. However, it is only
present in 25-50% of patients with acute sinusitis

4. Plain radiograph
• Opacification of the sinuses and gas-fluid level best seen in the maxillary
sinus. It does not allow assessment of the extent of the inflammation and its
complications. Ethmoidal and sphenoidal sinuses are difficult to assess on
plain radiography

5. Opacification of the left
maxillary sinus is noted.

6. CT
• The most common method of evaluation. Better anatomical delineation and
assessment of inflammation extension, causes, and complications.
• Peripheral mucosal thickening, gas-fluid level in the paranasal sinuses, gas bubbles
within the fluid and obstruction of the ostiomeatal complexes (common channel that
links the frontal sinus, anterior ethmoid air cells and the maxillary sinus to the middle
meatus) are recognized findings.
• Rhinitis, often associated with sinusitis, is often characterized by thickening of
the turbinates with obliteration of the surrounding air channels. This should not be
confused with the normal nasal cycle.

9. • Coronal image with (*) showing
obstruction of the infundibulum
and on left side involvement of the
hiatus semilunaris. Small arrows
also demonstrate sinus disease of
the anterior ethmoid air cells and
larger arrows point to bilateral
maxillary sinus mucosal
thickening. Pattern of sinus
disease involves the anterior
ostiomeatal unit.

10. • Axial image demonstrating
additional case of acute
sinusitis with arrows
pointing to air-fluid levels in
the ethmoid and sphenoid
sinuses.

11. • Pott puffy tumor refers to a non-neoplastic complication
of acute sinusitis. It is characterized by a primarily
subperiosteal abscess, and osteomyelitis. It is usually
sinus

12. Hyperostosis characterized by thickening
of the left frontal and ethmoid bone plate.
Opacification of the left frontal sinus and
ethmoid cells (sinus inflammation).

14. • Chronic sinusitis refers to ongoing long-term sinus
infection-inflammation that often develops secondary to
prolonged/refractory acute sinus infection.

15. • A characteristic feature on CT sinuses is sclerotic thickened bone
(hyperostosis) involving the sinus wall from a prolonged mucoperiosteal
reaction. Intrasinus calcification may be present. The presence of
opacification is not a good discriminator from an acute sinus infection.
• There are five main patterns of chronic inflammatory disease that classify the
disease into distinct anatomical/pathological groups and are dependant on the
drainage pathways affected. This classification helps the surgeon to select the
type of surgery needed

16. • ostiomeatal complex (OMC) pattern: maxillary sinus, anterior
ethmoid air cells, and frontal sinuses are affected due to
ostiomeatal complex
• infundibular pattern: isolated obstruction to the ethmoid
infundibulum and/or maxillary sinus ostium
• sphenoethmoidal recess pattern: inflammatory changes in the
sphenoethmoidal recess obstruct the sphenoid sinus in
with the posterior ethmoidal air cells
• sinonasal polyposis pattern: extensive polyps are occupying
the nasal cavity and the paranasal sinuses
• sporadic pattern: no clear pattern could be identified with
random mucosal thickening, polyps

17. Coronal bone window CT shows an
opacified left sphenoid sinus with
thickened walls and irregular inner
borders.

18. • Bilateral maxillary sinus
mucoperiosteal thickening
consistent with chronic sinusitis.
There is no facial bone fracture.

19. • Coronal image
with arrow
pointing to
maxillary sinus
polyp

20. • Coronal image
with large arrow
pointing to
"foamy" maxillary
sinus disease.

21. THANK YOU