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Clinical Problem Solving: Radiology
December 2002

Radiology Quiz Case 1: Diagnosis

Author Affiliations
 

R. NICKBRYANMDS. JAMESZINREICHMD

Arch Otolaryngol Head Neck Surg. 2002;128(12):1430. doi:

The computed tomographic scans show dilatation of all paranasal sinuses, particularly on the right side. The coronal images (Figure 1, Figure 2, and Figure 3) show marked enlargement of the maxillary sinuses and erosion of the fine bony septa in the ethmoid sinuses. The axial image shown in Figure 5 also shows erosion of the partition between the ethmoid sinuses and the sphenoid sinus on the right side. Erosion of the right orbit and of the bony partitions to the soft tissues of the face on the right side is also evident. For example, Figure 2 and Figure 5 show erosion of the lateral wall of the right maxillary sinus, with an air-filled space in the soft tissues of the right maxilla, which would account for the history of facial swelling during episodes of pressure change. Figure 1 and Figure 4 show erosion of the medial and inferior walls of the right orbit, which has produced an air-filled space in the right orbit, with exophthalmos of the right eye. Figure 1 also shows that there is obstruction of the right osteomeatal complex by mucosal disease, which may account for the more pronounced dilatation of the sinuses on the right side. The computed tomographic findings are consistent with a diagnosis of pneumosinus dilatans involving all the paranasal sinuses, but particularly on the right side.

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