Aspergillosis of the paranasal sinuses appears to be relatively rare in occurrence, but there is a growing incidence of it in accordance with the increasing use of antibiotics, steroid hormones, anticancer drugs, and radiation therapy. We have seen 15 cases of aspergillosis of the paranasal sinuses in which computed tomography (CT) was helpful for diagnosis. The characteristic feature of CT findings was the intermixture of high and low density areas in the affected paranasal sinuses, apparently caused by increased X-ray absorption due to calcification. These findings indicate that CT is useful in the preoperative diagnosis of aspergillosis of the paranasal sinuses.
Adult ; Aspergillosis/*radiography ; Female ; Human ; Male ; Middle Age ; Paranasal Sinus Diseases/*radiography ; Paranasal Sinuses/*radiography ; Retrospective Studies ; *Tomography, X-Ray Computed

Aspergillosis of the paranasal sinuses appears to be relatively rare in occurrence, but there is a growing incidence of it in accordance with the increasing use of antibiotics, steroid hormones, anticancer drugs, and radiation therapy. We have seen 15 cases of aspergillosis of the paranasal sinuses in which computed tomography (CT) was helpful for diagnosis. The characteristic feature of CT findings was the intermixture of high and low density areas in the affected paranasal sinuses, apparently caused by increased X-ray absorption due to calcification. These findings indicate that CT is useful in the preoperative diagnosis of aspergillosis of the paranasal sinuses.
Adult ; Aspergillosis/*radiography ; Female ; Human ; Male ; Middle Age ; Paranasal Sinus Diseases/*radiography ; Paranasal Sinuses/*radiography ; Retrospective Studies ; *Tomography, X-Ray Computed

We performed computed tomography (CT) of the nose and paranasal sinuses in 21 patients with chromium induced septal perforation or thinning. Twenty patients showed various magnitudes of septal perforation. Twelve of 20 had perforation at the mid portion of the cartilaginous nasal septum. One patient had a sheet-like thinning of septal cartilage. Sixteen patients had mucosal thinning of the nasal conchas. In most cases, unilateral involvement of the inferior concha was seen. Eleven of 21 cases showed paranasal sinus mucosal thickening and one patient had a cyst or polyp in the sinus cavity. The main finding was nodular thickening of mucosa. Septal perforation by inhalation of chromic acid was located in the cartilaginous septum and there was no destruction of the bony septum and wall of the sinuses.
Adult ; Chromium/*poisoning ; Human ; Male ; Middle Age ; Nose/*radiography ; Paranasal Sinuses/*radiography ; Support, Non-U.S. Gov't ; *Tomography, X-Ray Computed

We performed computed tomography (CT) of the nose and paranasal sinuses in 21 patients with chromium induced septal perforation or thinning. Twenty patients showed various magnitudes of septal perforation. Twelve of 20 had perforation at the mid portion of the cartilaginous nasal septum. One patient had a sheet-like thinning of septal cartilage. Sixteen patients had mucosal thinning of the nasal conchas. In most cases, unilateral involvement of the inferior concha was seen. Eleven of 21 cases showed paranasal sinus mucosal thickening and one patient had a cyst or polyp in the sinus cavity. The main finding was nodular thickening of mucosa. Septal perforation by inhalation of chromic acid was located in the cartilaginous septum and there was no destruction of the bony septum and wall of the sinuses.
Adult ; Chromium/*poisoning ; Human ; Male ; Middle Age ; Nose/*radiography ; Paranasal Sinuses/*radiography ; Support, Non-U.S. Gov't ; *Tomography, X-Ray Computed

PURPOSE: Pnumosinus dilatans is a rare disease that one or more of the paranasal sinuses are dilatated without functional alteration. The most frequently involved sites are frontal and sphenoid sinus. Facial asymmetric contour is the most common signs and nasal obstruction and pain may be combined. The purpose of reconstruction of pneumosinus dilatans is two-fold, to re-establish a permanent pressure equilibrium of sinus and to correct the possible facial deformities. METHODS: We present a case of a 24-year-old female with a 7-year history of protrusion of right malar region. Plane radiography and computed tomography detailed an abnormal expansion of the right maxillary sinus without thinning of bony wall, leading to diagnosis of maxillary pneumosinus dilatans. Surgical decompression and maxilloplasty were achieved by ostectomy of anterior wall of maxillary sinus and repositioning of removed bony fragment with miniplate. RESULTS: Post operative course was uneventful without complication and malar height became symmetric by physical and radiologic examination. CONCLUSION: We corrected successfully pneumosinus dilatans of maxillary sinus by surgical decompression and maxilloplasty. For this case, we reviewed literature related to this topic.
Congenital Abnormalities ; Decompression, Surgical ; Diagnosis ; Female ; Humans ; Maxillary Sinus* ; Nasal Obstruction ; Paranasal Sinuses ; Radiography ; Rare Diseases ; Sphenoid Sinus ; Young Adult

PURPOSE: Pnumosinus dilatans is a rare disease that one or more of the paranasal sinuses are dilatated without functional alteration. The most frequently involved sites are frontal and sphenoid sinus. Facial asymmetric contour is the most common signs and nasal obstruction and pain may be combined. The purpose of reconstruction of pneumosinus dilatans is two-fold, to re-establish a permanent pressure equilibrium of sinus and to correct the possible facial deformities. METHODS: We present a case of a 24-year-old female with a 7-year history of protrusion of right malar region. Plane radiography and computed tomography detailed an abnormal expansion of the right maxillary sinus without thinning of bony wall, leading to diagnosis of maxillary pneumosinus dilatans. Surgical decompression and maxilloplasty were achieved by ostectomy of anterior wall of maxillary sinus and repositioning of removed bony fragment with miniplate. RESULTS: Post operative course was uneventful without complication and malar height became symmetric by physical and radiologic examination. CONCLUSION: We corrected successfully pneumosinus dilatans of maxillary sinus by surgical decompression and maxilloplasty. For this case, we reviewed literature related to this topic.
Congenital Abnormalities ; Decompression, Surgical ; Diagnosis ; Female ; Humans ; Maxillary Sinus* ; Nasal Obstruction ; Paranasal Sinuses ; Radiography ; Rare Diseases ; Sphenoid Sinus ; Young Adult

OBJECTIVE: To compare computed tomography (CT) and magnetic resonance imaging (MRI) findings between two histological types of nasal hemangiomas (cavernous hemangioma and capillary or lobular capillary hemangioma). MATERIALS AND METHODS: CT (n = 20; six pre-contrast; 20 post-enhancement) and MRI (n = 7) images from 23 patients (16 men and seven women; mean age, 43 years; range, 13-73 years) with a pathologically diagnosed nasal cavity hemangioma (17 capillary and lobular capillary hemangiomas and six cavernous hemangiomas) were reviewed, focusing on lesion location, size, origin, contour, enhancement pattern, attenuation or signal intensity (SI), and bony changes. RESULTS: The 17 capillary and lobular hemangiomas averaged 13 mm (range, 4-37 mm) in size, and most (n = 13) were round. Fourteen capillary hemangiomas had marked or moderate early phase enhancement on CT, which dissipated during the delayed phase. Four capillary hemangiomas on MRI showed marked enhancement. Bony changes were usually not seen on CT or MRI (seen on five cases, 29.4%). Half of the lesions (2/4) had low SI on T1-weighted MRI images and heterogeneously high SI with signal voids on T2-weighted images. The six cavernous hemangiomas were larger than the capillary type (mean, 20.5 mm; range, 10-39 mm) and most had lobulating contours (n = 4), with characteristic enhancement patterns (three centripetal and three multifocal nodular), bony remodeling (n = 4, 66.7%), and mild to moderate heterogeneous enhancement during the early and delayed phases. CONCLUSION: CT and MRI findings are different between the two histological types of nasal hemangiomas, particularly in the enhancement pattern and size, which can assist in preoperative diagnosis and planning of surgical tumor excision.
Adolescent ; Adult ; Aged ; Female ; Hemangioma, Capillary/*radiography ; Hemangioma, Cavernous/diagnosis/*radiography ; Humans ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Nasal Cavity/radiography ; Paranasal Sinuses/*radiography ; Retrospective Studies ; *Tomography, X-Ray Computed ; Young Adult

BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA) in children with asthma, not associated with cystic fibrosis, is yet to receive the recognition it deserves. OBJECTIVE: To highlight the presentation of ABPA in children with asthma. METHODS: This retrospective review documents the occurrence of pediatric ABPA over a period of 31 years in one unit. Children with asthma, eosinophilia and infiltrates on chest radiograph were screened for ABPA. In these patients, demonstration of immediate hypersensitivity response against Aspergillus species along with serological profile and pulmonary function testing were done. Bronchography/computed tomography (CT) of the chest demonstrated central bronchiectasis (CB). CT of the paranasal sinuses was done in patients with upper airways symptoms. In those suspected with allergic Aspergillus sinusitis (AAS) consent was sought from the parents for the invasive procedure needed for the diagnosis of AAS. RESULTS: Of the 349 patients with ABPA diagnosed, 42 (12.03%) were in the pediatric age group. The mean age on presentation was 12.9 ± 4 years with a male preponderance. All patients had asthma and positive intradermal/skin prick test against Aspergillus species. Ring shadows, the most common radiological presentation, were seen in 28 of 42 patients. Bronchography/CT of the chest demonstrated CB, a feature pathognomic of ABPA, in 32 of 42 patients. High attenuation mucus plugs was observed in 7 of 36 patients while ABPA-seropositive was diagnosed in 10 of 42 patients. On imaging, sinusitis was seen in 20 of 30 patients with upper airways symptoms of whom eight had suspected AAS. Three parents consented for surgery, which confirmed the diagnosis. CONCLUSION: This study highlights the need to evaluate asthmatic children for ABPA as also to exclude AAS.
Aspergillosis, Allergic Bronchopulmonary ; Aspergillus ; Asthma ; Bronchiectasis ; Child ; Cystic Fibrosis ; Diagnosis ; Eosinophilia ; Humans ; Hypersensitivity, Immediate ; Male ; Mucus ; Paranasal Sinuses ; Parents ; Radiography, Thoracic ; Respiratory Function Tests ; Retrospective Studies ; Sinusitis ; Thorax

OBJECTIVE: We investigated low dose digital tomosynthesis (DT) for the evaluation of the paranasal sinus (PNS), and compared its diagnostic accuracy with a PNS radiography series (XR). MATERIALS AND METHODS: We enrolled 43 patients for whom XR, PNS DT, and OMU CT were performed. We measured effective doses (EDs) of XR, DT, and OMU CT using Monte Carlo simulation software. Two radiologists performed independent observation of both XR and DT. For seven PNSs, they scored anatomic conspicuity of sinuses and confidence on the presence of sinusitis using nine point scales. OMU CT was observed by the third radiologist and the findings were regarded as reference standard. We compared scores for conspicuity and sinusitis confidence between XR and DT. RESULTS: Mean EDs were 29 +/- 6 microSv, 48 +/- 10 microSv, and 980 +/- 250 microSv, respectively, for XR, DT, and CT. Mean scores for conspicuity were 6.3 and 7.4, respectively, for XR and DT. Sensitivity per patient basis for sinusitis detection were 52% and 96%, respectively, for XR and DT in observer 1 (p = 0.001) and 80% and 92% for observer 2 (p = 0.25). Specificities for sinusitis exclusion were 100% for both XR and DT for observer 1 and 89% and 100% for observer 2 (p = 0.50). Accuracies for sinusitis diagnosis were 72% and 98%, respectively, for XR and DT for observer 1 (p = 0.001) and 84% and 95% for observer 2 (p = 0.125). CONCLUSION: Patient radiation dose from low dose DT is comparable with that of PNS XR. Diagnostic sensitivity of DT for sinusitis was superior to PNS XR.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Monte Carlo Method ; Paranasal Sinuses/*radiography ; ROC Curve ; Radiation Dosage ; Radiographic Image Enhancement/*methods ; Sensitivity and Specificity ; Sinusitis/*radiography ; Statistics, Nonparametric ; Tomography, X-Ray Computed/*methods

Major orbital complications after the endoscopic sinus surgeries are rare and of these, optic nerve injury is one of the most serious. This study was to undertaken to analyze 3 cases of optic nerve injury after endoscopic sinus surgery. The three cases included one patient with a loss of visual acuity and visual field defect, and two patients with total blindness. In all cases, no improvement of visual acuity was observed despite treatment. It is important to frequently check the location and direction of the endoscope during surgery to avoid optic nerve injury. In addition, surgeons must have a precise knowledge of the detailed anatomy through cadaver dissections, an ability to interpret the PNS CT scan and experienced procedural surgical skills.
Adult ; Blindness/etiology ; Endoscopy/*adverse effects ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Optic Nerve Injuries/diagnosis/*etiology/radiography ; Paranasal Sinuses/*surgery ; Retrospective Studies ; Tomography, X-Ray Computed ; Vision Disorders/etiology ; Visual Acuity ; Visual Fields