Presentation
Left sinonasal expansion with left proptosis
Patient Data
Total opacification of the left ethmoidal air cells, frontal sinus, and both sphenoid sinuses with marked expansion of the frontal and ethmoids.
The following signal pattern in MRI:
- iso- to high signal on T1, high signal on T2 with an area of low signal (protein-rich content)
- markedly thin rim mucosal enhancement following gadolinium
- no central enhancement.
- marked lateral bulge of the left lamina papyracea, stretching the medial rectus. A 15 mm dehiscence is noted anteriorly.
Clear peri-sinus fat planes. No aggressive osseous erosions. Preserved nasal mucosal enhancement. No upper cervical lymphadenopathies.
Small retention cyst of the left maxillary antrum.
Mild mucosal thickening of the right frontal sinus and ethmoidal air cells.
The nasal septum is deviated towards the right side.
Case Discussion
MRI features are in keeping of sphenoid and frontoethmoidal mucoceles. They can be large resulting in proptosis. MRI was indicated to differentiate it from malignant sinonasal tumors.
Case courtesy Prof.Dr. Mohamed Eid, professor of radiology, Alexandria university, Egypt.
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