Advanced Radiologic

Interpretation: Sinuses

Sinusitis

Acute sinusitis: Waters view shows opaque right

maxillary sinus with classic air-fluid level in the
left (arrows).

Acute sinusitis: axial CT shows nearly

opacified left antrum with air-fluid level
(arrow).

Acute sinusitis

axial T1-weighted
MRI shows bilateral
maxillary sinus
mucosa thickening
and air-fluid level in
left antrum.

Acute sinusitis

axial T2-weighted
MRI shows marked
hyper-intense sinus
mucosa due to edema.
Note fluid level in left
antrum (arrow).

Chronic sinusitis

Waters view
showing small
sclerotic maxillary
antra (arrows show
left sinus).

Chronic sinusitis

Bony sclerosis
of maxillary
sinus (Patient L).

Chronic sinusitis: axial CT (Patient L) shows

marked thickening of antral walls (medial defects
are antrostomies - arrowed).

Aspergillus sinusitis: axial CT shows thickened

right antral mucosa with content high attenuation
due to mycetoma (arrow).

Retention Phenomenon
and the Mucocele

Retention cyst

Waters view
shows domed
soft tissue density
in left maxillary
sinus (arrow).

Retention cyst: axial CT reveals near spherical mass

of water attenuation surrounded by air in left antrum
(arrow).

Retention cyst: coronal CT of same patient

shows location of lesion in left maxillary sinus
(arrow).

Retention cyst: sagittal T1-MRI reveals smoothwalled mass of intermediate intensity in floor of
antrum (arrows).

Retention cyst

axial MRI (T2weighted) shows

round high-intensity
(water content) mass
in left antrum (arrow).

Mucocele: AP view of frontal sinus shows

opacification on right with faintly sclerotic
rim (arrow) in Patient M.

Mucocele

axial CT
of Patient
M shows
opacified right
frontal sinus.
Rounded margins
indicate expansion.
Note sclerotic rim
(arrows).

Axial T1 MRI

Axial T2 MRI

Mucocele: T1 shows hyperintensity of

rounded frontal air cell. T2 shows low intensity.

Nasal Polyps

Nasal polyps: PA shows opacified and widened

ethmoid complex with displacement of lamina
papyracea bilaterally, resulting in hypertelorism.

Nasal polyposis: Axial CT shows soft tissue mass

occupying the nasoethmoid region with bony
displacement and erosion. Mass is composed of
fingers of high and low attenuation.

Nasal polyposis: Coronal CT shows cascading

streaks separated by mucoid material in ethmoid
areas bilaterally (arrows).

Angiofibroma

Angiofibroma: axial CT with contrast shows

enhanced mass in pterygopalatine fossa, lateral
nasopharynx and infratemporal fossa.

Angiofibroma

internal
maxillary artery
angiogram shows
hypervascular
mass.

Angiofibroma: axial T1-weighted MRI shows medium

intensity mass occupying pterygopalatine fossa,
Parapharyngeal space and infratemporal fossa.

Angiofibroma: axial T2-weighted MRI shows

hyper-intense mass occupying pterygopalatine
fossa and parapharyngeal space. Mucosal edema
present in antra is consistent with sinusitis.

Osteoma

Osteoma: Caldwells view shows large, very dense

mass occupying left ethmoid region and expanding
into right orbit.

Osteoma (ivory osteoma):lateral view of

same patient.

Osteoma (ivory osteoma): axial CT shows mass of

uniform density in right ethmoid sinus region.

Osteoma (ivory
osteoma): coronal
CT shows mass of
uniform density
in right ethmoid
sinus region.

Malignant Tumors

Squamous-cell carcinoma: Waters view showing

opacification of left maxillary antrum with
destruction of nasal (purple arrow) and orbital
(pink arrow) walls.

Squamous-cell carcinoma: axial CT shows large

soft tissue mass in right maxillary sinus. Mass
has invaded retroantral fat pad and nasal cavity.

Squamous-cell carcinoma: sagittal T1-weighted

MRI shows mass of intermediate signal intensity
in maxillary sinus.

Squamous-cell carcinoma: axial T2-weighted MRI

shows hyper-intense thickened mucosa bilaterally
(sinusitis). The tumor is of intermediate intensity
in left antrum.

Adenoid cystic carcinoma:

Waters view reveals
opacification of left antrum
with destruction of
posterolateral wall (purple
arrow). Black arrows denote
intact wall on right.

Adenoid cystic carcinoma:

axial CT of same patient
shows expanded left antrum
with thinning of rear wall
(arrow). Content has mucoid
attenuation.

Adenoid cystic carcinoma:

coronal T1-weighted MRI in
another patient. Mass
occupies left nasal cavity,
antrum and ethmoid region
and has intermediate signal
intensity.

Adenoid cystic carcinoma:

axial T2-weighted MRI in
same patient shows mass of
intermediate to high intensity
in left antrum and nasal
cavity (arrow).