0:00

Let's have a look

0:01

see at this case.

0:03

So, on the bone windows, we notice that

0:07

the left maxillary sinus is opacified.

0:10

We see that the medial wall of the left maxillary

0:14

sinus is displaced inward, and it looks like there's

0:18

a mass here, which is extending into the nasal cavity.

0:22

So, this shape of the mass

0:25

is polypoid—this lobulated shape.

0:28

So, I'm gonna call this—if I see this

0:30

in the maxillary sinus by itself—I'd

0:32

call this polypoid mucosal thickening.

0:34

Or, in this case, where we have opacification

0:37

of the sinus, I'm gonna call this

0:39

chronic sinusitis with polyposis.

0:42

So, if we look on the coronal scan again, we see

0:45

that mass effect and remodeling of the bone of the

0:49

medial wall of the maxillary antrum.

0:51

We can see that there's some

0:52

expansion of the ostium through here.

0:56

Here's the normal maxillary sinus ostium.

0:58

It's kind of expanded, and then you have

1:01

this soft tissue within the nasal cavity.

1:04

Here's our inferior turbinate.

1:06

Inferior turbinate, but we have this

1:08

lobulated thing in the nasal cavity.

1:12

Here's our

1:13

paradoxical middle turbinate,

1:15

turning the opposite direction.

1:17

Here's the middle turbinate,

1:18

displaced by the soft tissue mass.

1:21

In the maxillary sinus ostium.

1:24

So, this is what we would call

1:26

chronic sinusitis with polyposis.

1:29

And you also note, on the soft tissue

1:32

window, the density of the secretions here.

1:35

So, this is quite dense.

1:37

We raise the possibility of fungal

1:40

superinfection in this case.

1:43

Or, this could be hemorrhage if the

1:44

patient had recent trauma, or it could

1:46

be hyperproteinaceous secretions.

1:49

I would favor this being fungal, mainly because

1:52

of the fact that it is sparing the periphery

1:56

of the paranasal sinus, which would be unusual

1:59

for hyperproteinaceous secretions.

2:02

So, polyps associated with superimposed

2:05

fungal infection and expansion of the maxillary

2:08

sinus ostium with secondary frontal sinusitis,

2:12

ethmoid sinusitis, and maxillary sinusitis.

2:15

Again, here's the nasal cavity—polyps, inferior

2:19

turbinate, middle turbinate—but then we have this

2:21

soft tissue mass in the nasal cavity medial to them.