Chronic rhinosinusitis

Case contributed by Dr Mostafa El-Feky


Headache and chronic nasal secretions.

Patient Data

Age: 35 years
Gender: Male

Markedly decreased size and near-complete opacification of both maxillary and sphenoid sinuses. Symmetrical inward bowing of the anterior wall of the maxillary sinuses bilaterally. Near-complete opacification of both frontal sinuses and ethmoid air cells with rarefaction of ethmoid bony septae. The ostio-meatal units, sphenoethmoidal recesses and frontal outflow tracts are compromised with thickened mucosa and retained secretions.

There is mild hyperostosis of the sinus walls of the frontal, sphenoid and maxillary sinuses with simultaneous demineralization of ethmoid bone septae, nasal conchae, uncinate processes and medial wall of both maxillary sinuses. Roomy nasal cavity with thickened mucosal and retained secretions. The nasal septum is wavy with more bowing towards the right side.

Case Discussion

The radiological features are reflecting chronic changes of rhinosinusitis. Bone sclerosis and demineralization can occur simultaneously in the setting of chronic sinusitis 1. Bony changes of chronic sinusitis include decreased sinus size, hyperostosis and occasionally bone demineralization if there is associated pathology like fungal infection and sinonasal polyposis.

Features of associated chronic rhinitis include roomy nasal cavities, resorption of ethmoid bulla and uncinate process, hypoplastic maxillary sinuses, erosion and bowing of lateral nasal walls.

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