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Clinical Problem Solving: Radiology
August 2005

Radiology Quiz Case 1: Diagnosis

Author Affiliations
 

R. NICKBRYANMDPATRICIA A.HUDGINSMD

Arch Otolaryngol Head Neck Surg. 2005;131(8):742. doi:10.1001/archotol.131.8.742-a

The CT scan showed an aggressively destructive lesion in the lateral sphenoid sinus wall, with diffuse induration of the orbital soft tissues and expansion of the cavernous sinus. It also showed opacification of the paranasal sinuses. The differential diagnosis of a destructive lesion at this location falls into 2 categories: neoplastic or infectious/inflammatory diseases. The neoplastic category includes malignant neoplasms with metastasis to the cavernous sinus, lymphoma, and perineural or direct extension from nasopharyngeal carcinoma. The infectious/inflammatory category includes intracranial complications due to sinusitis. Invasive fungal, as well as bacterial, sinusitis must also be considered. Immediate biopsy via an endoscopic approach and culture are mandatory. Early and accurate treatment may resolve the cranial neuropathies.

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