Imaging Evaluation Para nasal Sinuses - PowerPoint PPT Presentation

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Imaging Evaluation Para nasal Sinuses

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  1. Imaging EvaluationPara nasal Sinuses By: Ali Hekmatnia, MD HossainAhrar, MD

  2. Sinonasal Overview

  3. Sinonasal Overview

  4. OSTIOMEATAL UNIT (OMU)

  5. Sinonasal Overview

  6. Sinonasal Overview

  7. Sinonasal Overview

  8. Neoplasms of PNS • Very rare 3% • Predominately of older males • Delay in diagnosis due to similarity to benign conditions • Maxillary sinus: 70% • Ethmoidsinus: 20% • Sphenoid: 3% • Frontal: 1%

  9. Benign Lesions • Papillomas • Osteomas • Fibrous Dysplasia • Neurogenic tumors • Juvenile Angiofibroma

  10. Papilloma • Fungiform: 50%, nasal septum • Cylindrical: 3%, lateral wall/sinuses • Inverted: 47%, lateral wall Unilateral Malignant degeneration in 2-13%

  11. Inverted Papilloma • CT: Lobular mass on lateral nasal wall ± maxillary/ethmoidextension or intralesionalCa++ • • MR: "Convoluted," "cerebriform“ architecture on T2 & post-gadolinium images; necrosis = coexistent carcinoma

  12. Inverted papilloma

  13. Inverted papilloma

  14. Inverted papilloma

  15. Osteomas • Benign slow growing tumors of mature bone • Location: • Frontal, ethmoids, maxillary sinuses • When obstructing mucosal flow can lead to mucocele formation • CT: Density varies from dense (compact • type) to less ossified (fibrous type)

  16. Osteoma

  17. Osteoma

  18. Mycetoma

  19. Fibrous dysplasia • Medullary bone replaced by woven bone • MonostoticvsPolyostotic • Facial bone involvement greater in polyostoticform • CT/MR: Appearance varies with amount of fibrous tissue (classic "ground-glass“ appearance) • Malignant transformation to rhabdomyosarcoma has been seen with radiation

  20. Fibrous dysplasia

  21. Fibrous dysplasia

  22. Ossifying fibroma

  23. Neurogenic tumors • 4% are found within the paranasal sinuses • Schwannomas • Neurofibromas • When associated with Von Recklinghausen’s syndrome: more aggressive (30% 5yr survival). • Imaging: Well-circumscribed mass with bone remodeling (CT) • MR: Intermediate T1 signal T2 varies with cellularity; large lesions ± cystic degeneration

  24. Nerve sheet tumor

  25. Nerve sheet tumor

  26. Nerve sheet tumor

  27. Juvenile Angiofibroma • Adolescent male patient with nasal obstruction and epistaxis • Centered at sphenopalatine foramen with spread into pterygopalatine fossa, nasal cavity, and nasopharynx • Vascular mass with flow voids and avid enhancement

  28. Juvenile Angiofibroma

  29. Juvenile Angiofibroma

  30. Malignant lesions • Squamous cell carcinoma • Adenoid cystic carcinoma • Mucoepidermoid carcinoma • Adenocarcinoma • Hemangiopericytoma • Melanoma • Olfactory neuroblastoma • Osteogenic sarcoma, fibrosarcoma, chondrosarcoma, rhabdomyosarcoma • Lymphoma • Metastatic tumors • Sinonasal undifferentiated carcinoma

  31. Squamous cell carcinoma • Patient demographics: Adult patient (95%> 40 years); M > F • Location: • Maxillary sinus (70%) • Nasal cavity (20%) • Poorly defined with aggressive bone • destruction; heterogeneous enhancement

  32. SCC

  33. Lymphoma

  34. Minor Salivary Glands Tumors • 10% of PNS Tumors • Adenoid Cystic Carcinoma • MucoepidermoidCarcinoma • Perineuralspread • Adenoid Cystic Carcinoma