0:00

Let's take a look at this 53-year-old

0:03

who was being evaluated for acute sinusitis secondary to,

0:08

um, the inflammation that was causing a headache.

0:12

So as we look at the axial scans, uh, we're gonna start

0:15

with here the initial imaging of the lower maxillary sinus,

0:20

I would term, you know, showing this chronic inflammation

0:24

with sort of a polypoid appearance

0:26

to the mucosa in the inferior maxillary sinus.

0:29

However, as we get further superior, you notice that we have

0:33

that meniscus of a fluid level

0:35

bilaterally in the maxillary sinus.

0:38

We now come into the ethmoid science air cells

0:40

and we see the opacification bilaterally a little bit worse

0:44

on the right side than the left side,

0:46

and anteriorly worse than the posterior ethmoid air cells.

0:51

And we come to the sphenoid science

0:53

and once again, we have a meniscus of an air fluid level.

0:57

Not only that, but you have this wiss nest within the right

1:01

sphenoid science, which is analogous to that,

1:03

those bubbles that I mentioned.

1:05

Here you can see that little bubbly formation.

1:08

So again, this is evidence of an acute inflammation that is

1:13

superimposed on chronic inflammation.

1:16

When we have complete opacification of the air cells,

1:20

as you see on the right side in the ethmoid,

1:22

can't really tell whether that's from chronic

1:24

or acute infection

1:26

unless we have a prior study to show

1:28

that there's been a change.

1:30

The frontal sinuses, this would be described

1:32

as mucosal thickening in the frontal sinuses,

1:36

and again, you wouldn't have evidence to suggest

1:39

that this was an acute infection as opposed

1:41

to chronic infection.

1:43

So this is more likely termed acute on chronic

1:47

pan sinusitis

1:49

after looking at the axial scans in the bone window.

1:52

I would also look, obviously at the coronal images in order

1:55

to define the anatomy.

1:57

If this was a case again, where it was an inpatient

2:00

or it wasn't a candidate for endoscopic science surgery,

2:04

I wouldn't necessarily spend a lot

2:05

of time talking about the individual channels.

2:08

I would just kind

2:09

of generically say the osteo mutal units are opacified.

2:13

And same thing with the seno ethmoidal recess opacification.

2:17

So I wouldn't go into much detail.

2:19

If it was a patient that was being considered for surgery,

2:22

then you'd spend a little bit more time talking about the

2:25

nasal septal deviation

2:26

and any areas of the dehiscence along the walls

2:30

of the optic nerves, the carotid arteries,

2:33

the cribriform plate, and the laminate pap ratio.

2:37

However, it is beholden to us

2:41

to look at the soft tissue windows,

2:43

not just the bone windows,

2:44

and this is important for the detection of any spread

2:47

to the orbit spread intracranial

2:51

or spread outside the sinus into the adjacent soft tissue.

2:56

Again, the maxillary sinus perianal

2:59

Fat, or into the soft tissues anterior

3:03

to the face, as well as

3:05

with frontal sinus into the scalp region

3:08

where we may have something called the pots puffy tumor.

3:13

In any case, on these images,

3:14

I would be describing any abnormalities I might see in the

3:18

upper neck structures, the orbits versus the brain.

3:21

And finally, I would make a comment if there was associated

3:26

or coincidental mastoid

3:29

or middle ear cavity opacification

3:31

or Petri apex opacification, which might be another source

3:35

for a fever of unknown origin.

3:38

So this is a pretty good example

3:40

of acute on chronic sinusitis

3:43

that is involving predominantly the sphenoid sinuses

3:46

and the maxillary antra.