COMPUTED TOMOGRAPHY IN PATIENT WITH SINONASAL POLYPOSIS
Author: D.G. Petrenko
Sinonasal polyposis is a quite common finding during radiologist’s work. This is a form of chronic rhinosinusitis ranging from 2% to 16% of cases. Macroscopically, nasal polyps are seen as edematous formations, very often they appear to be white-yellow in color and soft in consistency.
Most often patients with sinonasal polyposis complain of nasal obstruction. Other clinical symptoms include nasal discharge, facial pain, chronic cough, dysosmia. Sometimes dull headache is present with bitemporal, top or posterior radiation.
Computed tomography (CT) is a method of choice for detection of sinonasal polyposis. In contrast to plain X-ray CT can quickly depict all the paranasal sinuses and nasal cavity, allows to create multiplanar reconstructions that can be of great help to clinicians. CT features of sinonasal polyposis include polypoidal, rounded soft-tissue masses which occupy and obliterate nasal cavity and paranasal sinuses, air-fluid levels, obstruction of ostiomeatal complexes, remodelling or erosion of bone structures.
Coronal reconstruction CT image of patient with normal pneumatization of paranasal sinuses. Ostiomeatal complexes are free. Also note curvature of nasal septum and mucosal thickening at the level of left inferior turbinate.
Coronal and sagittal reconstruction CT images of patient with sinonasal polyposis. Nasal turbinates and part of nasal septum are not visualized because of previous operation. There is a soft-tissue polypoidal obliteration of nasal cavity, maxillary and sphenoid sinuses, ethmoidal cells. The level of inferior nasal meatus is partly spared. Ostiomeatal complexes are blocked. Also note a remodelling of the walls of maxillary antra and bone defect of anterior wall of sphenoid sinus.