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Clinical Challenge
October 2016

Isolated Sphenoid Lesion

Author Affiliations
  • 1Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
  • 2Department of Radiology, University of Brescia, Brescia, Italy
JAMA Otolaryngol Head Neck Surg. 2016;142(10):1017-1018. doi:10.1001/jamaoto.2015.3690

A woman in her 40s had experienced dizziness and headache to the vertex with left retro-orbital irradiation for 1 year. She referred only to minor head trauma 15 years earlier. Findings from a physical examination were negative, while nasal endoscopy showed diffuse mucous rhinorrhea. A CT scan of the paranasal sinuses showed complete opacification of the left sphenoid sinus, a double-lined appearance of the sinus walls (an inner bony sclerotic layer and a thin external one) (Figure, A), and 2 bony defects of the sphenoid sinus walls next to the cavernous sinus along the floor (Figure, B). An MRI scan showed a concentric multistratified appearance of the sinus content. On T2-weighted images (Figure, C), a hyperintense line peripheral layer consistent with fluid retention, an irregularly thick hypointense line, consistent with the sclerotic bone visible on CT, a crescent-shaped heterogeneous material in the lower part, and a black oval area in the upper part of the sinus were identified. After gadolinium administration, volumetric interpolated breath-hold examination (VIBE) sequences revealed very intense enhancement of the oval black area in the upper part of the sinus, with no contrast enhancement of the remainder of the sinus (Figure, D). On paracoronal images, there was no cleavage plane between the hyperenhancing area in the sphenoid sinus and the bright signal of the internal carotid artery (ICA) in the cavernous sinus.

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