Presentation
Routine CT head for dementia screening. Asymptomatic.
Patient Data
The brain parenchyma appears normal without evidence of acute infarct or hemorrhage (within limits of non-contrast CT). No intracranial focal lesion. Age related diffuse cerebral involution and ventricular dilation is appreciated.
There is a well-defined rounded hypodense lesion seen in the right maxillary sinus with thin and smooth walls, consistent with a mucous retention cyst. This of similar size when compared to past imaging. The paranasal sinuses are otherwise unremarkable, and the nasal septum is midline.
The adjacent bony structures appear normal, and there is no evidence of bone erosion or thickening.
Impression:
A mucous retention cyst in the right maxillary sinus. No acute intracranial pathology.
Ventricular and surface CSF prominence is of likely of involutional age related changes. White matter hypodensities in the periventricular region were found, which may be indicative of long-term small vessel ischemic changes.
Mucosal thickening in right maxillary sinus with a hypodense and thinned wall structure is likely a mucous retention cyst. Otherwise the paranasal sinuses are clear.
Impression
No evidence of extra-axial collection or acute intracranial hemorrhage. No indication of a severe skull fracture. Likely mucous retention cyst in the maxillary sinus.
Case Discussion
Mucuous retention cysts (interchangeably referred to as "paranasal sinus cysts") are benign lesions commonly diagnosed on plain radiograph, CT or MRI imaging. Typically, such cysts are asymptomatic and show no significant size evolution on repeated imaging 1. In some cases, reported studies have demonstrated a reduction in size or spontaneous disappearance 1. However, ongoing evidence suggests mucous retention cysts may be implicated in nasal septum deviation, yet the implications of this remains undetermined 2.
Management is often conservative, with medical or surgical treatment typically not required 3.
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