鼻窦部结外Rosai-Dorfman病的诊治

目的　探讨鼻窦部结外Rosai Dorfman病的临床表现、组织学特征、诊断、鉴别诊断及治疗。方法　分析国内罕见的发生于鼻窦的结外Rosai Dorfman病的临床、组织学和影像学资料。结果　病变位于鼻窦 ,曾先后多次复发、手术切除并病理误诊。组织学分析可见大量梭形细胞混有泡沫细胞和少量浆细胞 ,胞质丰富呈泡沫样。免疫组化分析显示 ,组织细胞呈S 10 0和CD6 8阳性。结论　鼻窦部结外Rosai Dorfman病诊断困难 ,易误诊 ,临床应与鼻硬结病、嗜酸性肉芽肿、浆细胞瘤、良性纤维组织细胞瘤等进行鉴别 ,免疫组化细胞呈S 10 0、CD6 8阳性有助诊断。此病可采用化疗、放疗和手术治疗等综合治疗 ,对重要部位的病变侵犯 ,彻底的手术切除是最有效治疗方法 ,术后应跟踪随访     

The role of radiotherapy in the treatment of granuloma gangraenescens (lethal midline granuloma

The granuloma gangraenescens in the oral, maxillary and facial region is a rare disease. It is a destroying process in the region of palate, nose, paranasal sinuses, cheeks and orbit with characteristic signs of granulomatosis, infection and malignancy. The disease shows often a lethal development with cachexia or sepsis. Besides local inflammations and tumors, the granulomatosis of Wegener, and the so-called necrotizing sialometaplasia are above all to be excluded by differential diagnosis. Five cases are presented in order to describe the diagnostic and therapeutic problems. In literature, the greatest efficacy is attributed to radiotherapy, however, a detailed definition of the most efficient irradiation conditions cannot be given yet because of the small number of cases. Good long-term results or recoveries can be achieved in 75 to 80% of cases by a relatively high radiation dose of 40 to 50 Gy administered within four to five weeks. During the observation time of two to six years, no one of the five patients treated here only by megavoltage therapy showed a recurrence.     

真菌性鼻窦炎的CT诊断(附16例分析)

目的　探讨真菌性鼻窦炎的CT特征性表现及诊断价值。方法　分析 16例经手术病理证实的真菌性鼻窦炎CT表现。结果　真菌性鼻窦炎主要CT表现有 :病变仅发生于一侧 ,以上颌窦或以上颌窦为主 ,同时累及其他鼻窦 ;鼻旁窦内软组织呈结节状或息肉样不规则增生 ,内可见点状、结节状钙化 ;部分窦腔增大 ,骨壁破坏。结论　真菌性鼻窦炎在CT表现上有特异性 ,CT对该病诊断有重要价值     

霉菌性鼻窦炎的CT诊断

目的 探讨霉菌性鼻窦炎CT特征性表现及诊断价值。方法 回顾性分析12例经手术病理证实的霉菌性鼻窦炎CT表现，提出诊断和鉴别诊断要点。结果 霉菌性鼻窦炎主要CT表现有：病变为单侧性，对侧鼻窦正常；病变仅位于上颌窦或以上颌窦为主，累及其他鼻窦；病变窦腔密度增高，不均匀，内有小团状，砂粒状，条状极高密度区；可有鼻窦骨质破坏。结论 霉菌性鼻窦炎的CT表现上有特异性，CT是诊断该病有价值的方法。     

眶壁骨瘤的CT诊断

作者对手术病理证实的７例眶壁骨瘤的ＣＴ资料进行了回顾性分析。７例术前均经ＣＴ明确诊断，表现为眶内骨样密度肿块与眶壁相连，部分病例肿块侵及邻近副鼻窦。ＣＴ检查可明确眶壁骨瘤的形态、位置、大小及其与邻近组织的关系，对临床治疗有指导作用。     

CT findings in involvement of the paranasal sinuses by lepromatous leprosy.

The role of nasal infection in the transmission of leprosy has been extensively studied. Leprosy can affect the paranasal sinuses due to mucosal continuity and bacillaemia. This prospective study was performed on 25 untreated patients with lepromatous leprosy. 5 mm contiguous axial and coronal CT sections of paranasal sinuses, on soft tissue and bone windows, were obtained in all patients. Each sinus was examined for mucosal thickening, soft tissue densities and bony outlines. Representative biopsies were taken from ethmoid sinus to confirm the radiological diagnosis in 12 patients with multiple paranasal sinus involvement. Ethmoid aircells were involved in 20 patients (80%). Maxillary, frontal and sphenoid sinuses showed abnormalities in 12, four and three patients, respectively. The ethmoid biopsy showed involvement by lepromatous leprosy in seven of 12 patients (58.3%). Involvement of paranasal sinuses is common in lepromatous leprosy and is of considerable epidemiological significance.     

CT characteristics of orbital pseudotumors and other orbital inflammatory processes

Orbital pseudotumor is a nonspecific inflammatory process of unknown etiology that may mimic a true orbital neoplasm, specifically lymphoma. It exhibits a highly variable clinical and radiographic presentation. Thirty-nine patients with a presumptive diagnosis of orbital inflammatory disease were examined with CT and evaluated with respect to 13 findings associated with inflammatory disease of the orbit. Pseudotumor was included as part of the differential diagnosis in 25 patients. Twenty-one cases received a final (clinical) diagnosis of pseudotumor. The remainder were comprised of a broad range of orbital inflammatory conditions. Key radiographic features required to entertain or exclude the diagnosis of pseudotumor included establishing the presence of an orbital mass, extraocular muscle enlargement, bony erosion, enhancement, and associated paranasal sinus disease.     

Neuroblastoma of the olfactory nerve. Radiotherapy experiences in 6 patients

Six patients with neuroblastomas of the olfactory nerve (esthesioneuroblastoma) are presented who were irradiated between 1983 and 1986 at the Medical Radiologic Institute of Tübingen. Clinical manifestations, diagnostics, histology, therapy, and courses are compared and discussed with regard to a survey of literature. An attempt is made to find out the value of radiotherapy in the treatment of this rare disease. In stage A (tumor restricted to the nasal cavity, 1 patient), a local tumor control of up to now 28 months could be achieved by a treatment combination of surgery and radiotherapy. A treatment consisting of surgery or radiotherapy alone should even in this stage only be performed in connection with a close follow-up because of the increased local recurrence risk. Tumors of stage B (manifestation in the nasal cavity and the paranasal sinuses) did not occur in this group of patients. Five patients suffered from tumors of stage C (tumor extent beyond the paranasal sinuses). A good palliative effect was obtained temporarily by radiotherapy alone in three out of these patients showing large inoperable tumors and rapidly progressing clinical symptoms. A complete remission now lasting 16 months was achieved only in one patient by radical surgery with unilateral evisceration of orbit and homogeneous postirradiation. In case of stage C tumors it is recommended to perform, if possible, a radical tumor excision with evisceration of orbit in case of unilateral manifestation in the orbit and a postirradiation applying a radical, large volume technique. In order to reduce the risk of radiogenic cerebral necroses, it should be attempted to avoid dose maxima as they can occur when applying a combined ventro-dorsal and lateral irradiation technique.     

Orbitocranial asymmetry.

Eleven cases are chosen to illustrate the differential diagnosis of deforming lesions of the bony orbit and its vicinity, which cause unilateral proptosis or other cranio-facial disfigurement. Three distinct varieties of orbito-cranial neurofibromatosis are distinguished, and they are contrasted with other deforming lesions of childhood--unilateral craniosynostosis, chronic juvenile subdural hygroma of the temporal fossa and congenital facial hemihypertrophy. Adult lesions are represented by intrinisic tumours of the orbit and paranasal sinuses, and by the commonest two processes deforming the sphenoid bone, meningioma and osseous fibrous dysplasia.     

Traumatic injuries: imaging of facial injuries

Facial injuries are common and require radiologic evaluation to plan treatment. The role of imaging is to detect fractures, describe their morphology and topography, and evaluate adjacent soft tissue damage. Computed tomography is the imaging method of choice for an accurate diagnosis and for depicting the complex anatomic structures of the maxillo-facial region. Magnetic resonance imaging plays a limited role, mainly in the assessment of lesions of orbital soft tissues. This paper reviews the most common traumatic injuries of facial bones, paranasal sinuses, orbits and mandible.     

A modified Towne's view for radiography of the orbit and maxillary antrum.

Routine radiographic examination of the paranasal sinuses and facial bones does not adequately demonstrate the posterolateral margin of the orbital floor. An anteroposterior projection with a 20 degrees cephalo-caudad angulation centered at the glabella adequately demonstrates the posterior and lateral orbital floor and the posterolateral margin of the orbital floor in all patients.     

Aspergillosis of the paranasal sinuses

Summary The CT appearances of 13 cases of pathologically proven aspergillosis involving paranasal sinuses were reviewed. Symptoms included rhinorrhea, nasal obstruction, headache, facial pain and foul smell from the nose. At operation, these lesions appeared yellowish, brownish, grey or black in colour, and contained dirty or muddy material. Microscopic examination of the tissue removed showed anAspergillus ball with chronic inflammation but without invasion of the nasal or sinus mucosa in 6 cases, and tissue invasion with necrosis and inflammation in 7. The structures involved, in order of frequency, were: maxillary sinus, nasal cavity, ethmoid sinus, orbit and cavernous sinus. The orbit was involved in 2 cases, therefore categorized as invasive; the other 11 cases were non-invasive as judged by CT. Calcification was seen in the lesions of 9 cases. In most cases the adjacent bony structures showed areas of erosion and sclerosis. Aspergillosis should be suspected in the presence of a mass in the paranasal sinuses or nasal cavity with calcification within it, which may not appear solid or dense and is separate from the walls of the sinus.     

CT of the inferomedial orbit and the lacrimal drainage apparatus: normal and pathologic anatomy

The normal and pathologic CT anatomy of the lacrimal drainage apparatus was examined during study of the orbits, nasal cavity, and paranasal sinuses in 100 patients with a variety of clinical complaints related to the inferomedial orbit. The bony lacrimal fossa, the nasolacrimal canal, and the fluid- or air-filled lacrimal sac and nasolacrimal duct were readily recognized in all cases. The lacrimal fossa and sac are found at the inferomedial orbit and are preseptal structures. Cystic expansion of the lacrimal sac (dacryocystitis) may mimic orbital abscess clinically; however, the radiographic recognition of a cystic, peripherally enhancing mass centered at the lacrimal fossa should exclude postseptal abscess and permit more conservative therapy. Obstruction or invasion of the drainage apparatus by tumor, infection, or posttraumatic scarring is readily depicted by CT. Sagittal/coronal images reformatted from thin transverse axial sections are often useful in defining the origin of an inferomedial orbital mass and its relation to the lacrimal sac when clinical studies and axial CT findings are equivocal.     

Role of routine nonenhanced head computed tomography scan in excluding orbital,maxillary, or zygomatic fractures secondary to blunt head trauma

The purpose of this paper is to determine the necessity of a dedicated facial bone/orbital computed tomography (CT) scan for fracture surveillance in patients who have suffered blunt head trauma and whose routine nonenhanced head CT scan is negative. It is based on a retrospective review of 115 patients presenting to the Emergency Department at a level I trauma center after blunt head trauma. Included patients underwent both a nonenhanced head CT scan and a dedicated facial bone or orbit CT. Standard nonenhanced head CT protocol was followed for each patient as per department protocol. A positive head CT scan is defined to include either an air–fluid level within the paranasal sinuses or fracture of the maxillary, orbital, or zygomatic osseous structures. A negative scan demonstrates none of these findings. Intracranial/parenchymal pathology was not evaluated in this study. Sixty-five of the 115 patients had a negative head CT scan as defined above. Of these 65 patients, none subsequently had a positive facial bone or orbit CT scan. The sensitivity and negative predictive values of a negative routine nonenhanced head CT scan for fracture surveillance are both 100%. In the setting of blunt trauma, a negative nonenhanced head CT scan precludes the need for a dedicated facial bone or orbital CT scan in the evaluation for orbital, maxillary, or zygomatic fractures. This saves the patient unnecessary radiation exposure, health care costs, and time spent in the emergency radiology department.     

Multifocal fibrosclerosis: a new case report and review of the literature

A case of multifocal fibrosclerosis is presented with MR images. Bilateral sclerosing orbital pseudotumor invading cavernous sinuses were the presenting disorder. Magnetic resonance imaging showed involvement of paranasal sinuses bilaterally and multiple supratentorial dural masses. Retroperitoneal fibrosis was associated with the condition. Multifocal involvement should be considered in patients with sclerosing orbital pseudotumor and an imaging approach should be performed on the appropriate clinical condition to document possible coexistence of other disorders including retroperitoneal fibrosis, mediastinal fibrosis, sclerosing cholangitis, and Riedel's thyroiditis     

Complicated acute pediatric bacterial sinusitis: Imaging updated approach

Acute bacterial sinusitis is usually a clinical diagnosis. Orbital complications require emergent evaluation with computed tomography. Using the orbital septum as an anatomic landmark, such infections can be classified as pre- or postseptal and treated with the most adequate therapy, ie, oral or intravenous antibiotics or surgical endonasal drainage. Intracranial complications can be seen in 3.7% to 11% of these patients, often with subtle clinical symptoms and signs. Radiologists play a decisive role in the final management of these patients and should be familiar with the most relevant complications. In this article, we present a retrospective review of all pediatric patients referred to our department for paranasal sinuses and orbital computed tomography because of acute complicated bacterial sinusitis. They were studied with an emergent enhanced facial and cranial computed tomography within 24 hours of admission, followed by magnetic resonance imaging when intracranial complications were suspected. Particular emphasis is placed on the imaging algorithm and the most relevant complications; we correlate imaging findings with clinical and bacteriological data.     

CT scanning in the diagnosis of orbital disease

The application of CT scanning to the diagnosis of orbital disease is considered in the context of the general differential diagnosis of unilateral exophthalmos. The advantages of using a body scanner for orbital diagnosis are stressed, coupled with the high resolution facility available with the EMI CT 5005 machine. In addition to orbital space-occupying lesions and dysthyroid disease, secondary involvement of the orbit by paranasal sinus and middle fossa pathology is described, and the value of CT considered in respect to these lesions. The relationship of CT to other modalities of orbital investigation is discussed and their current place in orbital diagnosis evaluated.     

Sinonasal Diseases Affecting the Orbit – A Radiological Pattern-Based Approach

The orbit is surrounded on three sides by paranasal sinuses with only a thin rim of bone separating the 2 at each site, predisposing it to the risk of being affected by the diseases of primary sinonasal compartment. A wide range of sinonasal pathologies can show orbital involvement and may present mainly with orbital symptoms. While most of these are due to contiguous involvement, a few others may be caused by systemic diseases that often involve both, the orbit and the sinuses in a noncontiguous manner. In this article, we have classified these diseases based on their radiological appearances into 5 patterns: Pattern 1 – Fat stranding predominant, Pattern 2 – Soft tissue without bone destruction, Pattern 3 – Soft tissue with bone destruction, Pattern 4 – Bony pathologies, Pattern 5 – Sinus volume changes. Various pathologies have been classified into these patterns considering the most typical changes in each of the disease processes. We briefly review these patterns, their hallmark radiological signs, typical examples of each pattern as well as review the various diseases process highlighting their radiological appearances. Imaging plays a crucial role in identifying the epicentre of the disease process, narrowing down the differential diagnoses, identifying management modifying complications, planning the surgical management as well as in the follow up of several such lesions. This unique radiological approach, although not absolute, aims to provide a new insight and working algorithm to help narrowing down the differential diagnoses.     

Post-traumatic orbit evaluation by three-dimensional surface reconstructions

Post-traumatic orbital osseous and soft tissue surface evaluation was performed using high resolution computerized tomography and three-dimensional surface reconstructions (3DSR) using specially developed computer software. Four patients with facial fractures involving the orbit are presented as examples of the technique. Orbital volume was measured and surface images prepared using the original CT scans as input to CT computer software developed for this purpose. The results simplify interpretation of the nature and extent of traumatic orbital disruption. The interpretation of serial high resolution CT scans of the orbit (now obtained routinely in fractures involving the orbit) has been augmented by employing three-dimensional surface reconstructions (3DSR).