Sinonasal polyposis refers to the presence of multiple benign polyps in the nasal cavity and paranasal sinuses.
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Epidemiology
Sinonasal polyposis is most commonly encountered in adults and rare in children. Polyps are the most common expansile lesions of the nasal cavity 8.
Associations
Conditions known to be associated with polyps include 10:
Clinical presentation
Clinical symptoms of sinonasal polyposis may include progressive nasal obstruction, rhinorrhea, facial pain, headache, anosmia, etc. 3. It can also cause a particular pattern of chronic sinusitis as a result of obstruction of the drainage pathways of the paranasal sinuses.
Pathology
Polyps are formed by the influx of fluid into the lamina propria of the sinonasal Schneiderian mucosa 8,9.
Classification
The Meltzer grading system is a clinical grading system that is as follows ref:
grade 0: no visible polyposis
grade 1: single polyp confined to the middle meatus
grade 2: multiple polyps in the middle meatus
grade 3: extending beyond the middle meatus
grade 4: nasal cavity obstruction
Radiographic features
CT
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extensive mucosal polyps occupying and obliterating the nasal cavity and the paranasal sinuses
usually, they are hypodense but may be hyperdense due to increased protein content or fungal infection
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associated local benign bone remodeling or erosion (as opposed to a mucocele where the entire sinus is expanded 6)
enlargement of infundibula
attenuation of the ethmoid sinus walls and nasal septum
occasionally sparing the inferior nasal meatus
truncation of middle turbinate 4
opacified ethmoid sinuses with convex lateral walls and gas-fluid levels
a concurrent fungal sinus infection may be present
Complications
Differential diagnosis
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can be indistinguishable
usually spares the nasal cavity
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commonly associated with polyps
hyperdense central areas
MRI may show low T1 and T2 signal
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granulomatosis with polyangiitis
centered in the nasal cavity
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