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Article
November 15, 2010

Radiology Quiz Case 1

Arch Otolaryngol Head Neck Surg. 2010;136(11):1140. doi:10.1001/archoto.2010.189-a

A 53-year-old woman presented with an approximately 5-year history of recurrent headaches, nasal airway obstruction, and discolored nasal discharge. She was treated with multiple antibiotic courses, without noticeable improvement. A computed tomographic scan revealed marked enlargement of the sphenoid sinus (Figures 1, 2, and 3). There was circumferential osteoneogenesis of the sinus wall (Figure 1, arrowheads), but the sinus was completely aerated. The intersinus septum was absent, but both of the sinus ostia were widely patent (Figures 2and 3, arrowheads). Multiple computed tomographic scans performed over several years had similar findings, with variable amounts of fluid in the sinus but never complete opacification.

The patient underwent endoscopic bilateral sphenoidotomies, including the natural ostia. Both ostia were found to be patent but displaced anterolaterally. Histopathologic analysis of the surgical fragments showed noncaseating granulomatous sinusitis, focal squamous metaplasia, and reactive bony changes. Special stains were negative for mycobacteria and fungi. The patient's recovery was uneventful, and her symptoms are in remission.

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