关于鼻窦鼻腔高密度影，耳鼻喉科医生想知道什么？

Read Like an Expert: Sinonasal Opacification, What Otorhinolaryngologist Wants to Know?

Shams Jubouri M.D., Priyanka Prakash M.D.

Saint Vincent Hospital 

Radiology department 

Worcester, MA

Report Check List(2) :

 Drainage pathways opacification. 

 Anatomic variation.

 Extent and type of sinus disease  complete or partial opacification, mucosal thickening, or mass.

 Extra sinus abnormalities  soft tissue, orbital and intracranial abnormalities

Normal Anatomy and Variants(2,3) :

Drainage pathways -Normal anatomy  :

1. Osteomeatal complex or unit (OMC). 

2. Frontal recess. 

3. Sphenoid ostia and sphenoethmoidal recess.

4. Cribriform plate depth and asymmetry.

5. Agger Nasi cell extension. 

6. Ethmoid artery course.

Normal Variation:

1. Septal deformities and variants.

2. Turbinate variants.

3. Uncinate process variants. 

4. Frontal recess variation. 

5. Lamina papyracea congenital dehiscence.

6. Sphenoid sinus dehiscence. 

7. Intersphenoid septum variation

8. Haller cells (infraorbital ethmoid cells).

9. Onodi cells (sphenoethmoidal air cells).

10. Clinoid process pneumatization. 

Sinonasal Opacification Check List(2,8) :

 Isolated or diffuse process (opacification pattern). 

 Sinus size (small, normal size, or expanded).

 Walls (normal, thickened and sclerotic, thinned, or eroded).

 Density or signal intensity. 

 Extension and complication outside the sinus. 

 Enhancement. 

 Mimics such as encephalocele or intracranial tumor extension.

Pattern of opacification(2,8) :

 Helpful with surgical planning.  

 Infundibulum pattern: Maxillary opacification. 

 Osteomeatal pattern: Maxillary, frontal and anterior ethmoid.

 Sphenoethmoidal recess pattern: Sphenoid and posterior ethmoid. 

 Sinopolypodal pattern: All sinuses and nasal cavity.

 Unclassified/random pattern: Unrelated to polyposis or ostea.

Causes of opacification :

Tumors:

1. Inverted papilloma.

2. Juvenile angiofibroma.

3. Squamous cell carcinoma.

4. Sinonasal undifferentiated carcinoma (SNUC).

5. Enthesioneuroblastoma.

6. Mesenchymal tumors.

7. Lymphoma.

Inflammatory/Infectious:

1. Acute sinusitis.

2. Chronic sinusitis.

3. Silent Sinus Syndrome.

4. Mucocele.

5. Allergic fungal sinusitis.

6. Fungal ball/Mycetoma.

7. Acute invasive fungal sinusitis.

8. Chronic invasive fungal sinusitis.

9. Sinonasal polyposis.