Imaging Evaluation Para nasal Sinuses

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

13. Inverted papilloma

15. Inverted papilloma

17. Inverted papilloma

18. 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)

20. Osteoma

22. Osteoma

24. Mycetoma

25. 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

27. Fibrous dysplasia

29. Fibrous dysplasia

31. Ossifying fibroma

32. 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

34. Nerve sheet tumor

36. Nerve sheet tumor

38. Nerve sheet tumor

39. 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

41. Juvenile Angiofibroma

43. Juvenile Angiofibroma

44. 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

45. 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

47. SCC

49. Lymphoma

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