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Clinical Problem Solving: Radiology
Oct 2011

Radiology Quiz Case 2: Diagnosis

Arch Otolaryngol Head Neck Surg. 2011;137(10):1040. doi:10.1001/archoto.2011.165-b

Diagnosis: Giant rhinosinusal empty mucocele

The mucocele was first described as a clinical entity in 1818. Then, in 1896, the term mucocele was introduced and defined as the retention of secretory products of the mucous membrane within a bony cavity wall. The mucocele is the most common lesion that causes expansion of the paranasal sinuses. It is an epithelial-lined, mucus-containing sac that can almost completely fill a paranasal sinus cavity. It is characterized by progressive thinning and distension of 1 or more of the bony sinus walls. There are 2 theories to explain the gradual enlargement of a mucocele with erosion of adjacent bone. The pressure necrosis theory states that accumulation of mucus in a closed space exerts pressure on adjacent bone, leading to necrosis of bone and thereby permitting mucocele expansion. Lund1 proposed that mucosal inflammation results in the release of prostaglandin E2 and collagenase from the lining of the mucocele, resulting in bone resorption. The mucocele is a relatively uncommon condition, occurring most frequently in the frontoethmoidal region.

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