0:00

This is a very common presentation that we see in

0:05

neuroradiology when we're looking at a patient who

0:08

may or may not have any sinus symptoms. In this case,

0:12

as you can see in the right maxillary antrum,

0:15

you see hyperdense sinonasal contents, and it's

0:20

seen both on the axial as well as the coronal scan.

0:23

It's central within the paranasal sinuses.

0:26

So we might ask ourselves, is this just

0:29

hyperproteinaceous secretions within the sinus, or

0:32

could this be a non-aggressive form of fungal sinusitis?

0:37

Well, one of the things that's helpful here

0:39

is to look at the wall of the right maxillary

0:43

antrum when we compare the thickness of

0:45

the wall of the right maxillary antrum.

0:46

With that of the left maxillary antrum,

0:48

we see that it's thickened.

0:50

So this is a patient who has a

0:52

chronic infection with osteitis.

0:56

We can define that correctly.

0:58

Now we look at the contents.

1:00

This is not where I would say that it's a uniform,

1:04

hyperdensity to the secretions that I would

1:06

expect with hyperproteinaceous secretions.

1:09

In this case, we have little focal areas of

1:12

calcification or hyperdense within the sinus.

1:16

And we might even suggest that there's a little

1:18

bit of an expansion at the maxillary sinus ostium.

1:22

You notice in this case that the patient has

1:23

had a previous orbital floor fracture or maybe

1:26

actually be an acute orbital floor fracture here.

1:29

But we're looking at the sinus though.

1:30

Ignore the orbit on the left side.

1:33

Let's look at this.

1:34

Different patient again, where we have this

1:37

hyperdensity centrally within the paranasal sinuses.

1:42

It includes the ethmoid sinus here in the frontal sinus.

1:45

We also see that.

1:47

Hyperdensity.

1:48

This is most likely sac growth

1:51

of fungi within chronic sinusitis.

1:56

It's because of the appearance of it in

1:58

this body pattern, almost a mosaic pattern.

2:01

It's less likely to represent just

2:03

hyperproteinaceous secretions.

2:06

The presence of that expansion and the

2:09

powdery nature would also suggest that

2:11

this could represent more likely fungal.

2:14

Infection or superimposed fungal

2:17

infection on chronic sinusitis.

2:18

Now, this is not the aggressive form, right?

2:20

We know that the wall is thickened.

2:22

We have chronic osteitis.

2:24

This is not acute invasive fungal sinusitis.

2:27

This is a chronic inflammation with

2:30

superimposed fungal infection in these sinuses.