侵袭型霉菌性鼻窦炎的CT诊断与临床

目的 探讨侵袭性霉菌性鼻窦炎CT表现及诊断价值。方法 回顾性分析32例经手术病理证实的侵袭型霉菌性鼻窦炎CT及临床表现，提出诊断和鉴别诊断要点。结果 侵袭型霉菌性鼻窦炎主要CT表现有：病变多为单侧性，对侧鼻窦正常；病变多位于上颌窦或以上颌窦为主，可累及其他鼻窦；病变窦腔密度增高，不均匀，内有小团状，砂粒状、条状高密度钙化影；有鼻窦壁骨质破坏。结论 CT检查是诊断侵袭型霉菌性鼻窦炎有价值的方法.     

霉菌性和慢性化脓性鼻窦炎的CT鉴别诊断

目的:探讨CT在霉菌性和慢性化脓性鼻窦炎鉴别诊断.方法:对52例经手术后病理证实为霉菌性和慢性化脓性鼻窦炎患者的影像学、临床及手术病理资料进行回顾性分析.结果:霉菌性和慢性化脓性鼻窦炎CT表现的差异主要在以下3个方面:(1)病变范围:霉茵性鼻窦炎受累情况以单窭病变为主,66.7%的病例病变累及单侧上颌窦;慢性化脓性鼻窦炎多为双侧多鼻窦受累.79.4%病例病变累及双侧多个鼻窦.(2)病变密度:慢性化脓性鼻窦炎窦腔黏膜增厚、软组织团块影的密度均匀、无钙化灶;78.9%的霉菌性鼻窦炎的窦腔病变中有条带状、斑点状或团块状的高密度钙化影.(3)窦壁骨质的受累状况:化脓性鼻寞炎病例中未见窦腔骨质破坏;而霉菌性鼻窦炎病例中,44.4%的病例有不同程度的骨质吸收和破坏,位于上颌窦内侧壁.结论:CT扫描对霉菌性和慢性化脓性鼻窦炎的鉴别诊断有一定的价值.     

霉菌性鼻窦炎的CT诊断（附11例报告）

目的 探讨霉菌性鼻窦炎的CT诊断价值。方法 收集经手术病理证实的霉菌性鼻窦炎11例,其中曲菌病6例,毛菌病3例,隐球菌2例,回顾性分析它们的X线、CT表现。结果 霉菌性鼻窦炎CT表现特点为：①单侧发病;②病变仅位于上颌窦或以上颌窦为主;③病变窦腔密度增高、不均匀、CT值较高,45－85Hu,内可有小砂粒状、线团状钙化;④鼻窦局限性骨质破坏,可伴增生。结论 霉菌性鼻窦炎X线表现无特异性,而T则有一定特异性,对诊断有一定帮助。     

CT、MRI对霉菌性鼻窦炎的诊断价值

目的：探讨CT、MRI对霉菌性鼻窦炎的诊断和鉴别诊断价值。方法：回顾性分析32例霉菌性鼻窦炎CT、MRI表现。结果：霉菌性鼻窦炎的CT表现主要为：①90.6%的病变内有高密度钙化影。大多呈斑点状,位于窦腔中央,与窦壁无关。②50.0%的窦壁存在骨质破坏,常见于上颌窦内侧壁,其特点是伴有窦壁骨质增生。霉菌性鼻窦炎的MRI表现为上颌窦病变中央大部分呈T1、T2低信号。结论：霉菌性鼻窦炎有较特征性的CT、MRI表现,CT对病灶内钙化显示较MRI更明确,而且经济,是首选的影像检查方法,MRI在评估病变窦腔外受累及与肿瘤鉴别方面优于CT。     

霉菌性鼻窦炎的CT诊断(附18例分析)

目的:探讨CT对霉菌性鼻窦炎的诊断价值。材料与方法:收集18例经病理证实的霉菌性鼻窦炎的影像资料进行分析。结果:根据其CT表现可归纳如下特点:①病变多为单侧性;②病变部位以上颌窦为主;③不均匀密度中夹杂高密度钙化影;④局限性骨质增生与破坏。结论:CT不仅能明确病变部位,而且在定性诊断方面具有特征性意义;与细菌性鼻窦炎及鼻窦肿瘤有鉴别价值。     

霉菌性鼻窦炎的临床、病理及CT 影像研究

本文搜集经病理证实的21例霉菌性鼻窦炎,对比分析其临床、病理及ＣＴ表现并探讨其发病机理及鉴别诊断。1　资料与方法搜集1989年至1999年在我院诊治、有完整资料的21例霉菌性鼻窦炎,男6例,女15例。年龄37～70岁,平均482岁,病史半年至20余年。全部病例均有术前ＣＴ检查,采用西门子ＳＯＭＡＴＯＭＤＲ3及岛津4800ＴＦＣＴ扫描机,层厚和间隔5ｍｍ,轴位和/或冠状扫描。1例病人同时行ＭＲ检查。观察内容:①临床:病史,症状,鼻腔检查及预后;②病理:常规ＨＥ染色,观察指标为霉菌菌丝,黏膜血管浸润及钙化;③霉菌培养:手术切除组织或分泌物的微生物培…     

霉菌性鼻窦炎的CT表现与其诊断价值的研究

目的:探讨霉菌性鼻窦炎的CT表现和诊断价值。材料与方法:回顾性分析26例经病理证实的霉菌性鼻窦炎的CT表现,重点观察鼻窦病变的部位、密度以及窦壁的骨质改变等。结果:①霉菌性鼻窦炎的病变范围多局限于单侧,以上颌窦多发。②窦腔软组织块影内可见线团状、斑点状或云絮状钙化影。③霉菌性鼻窦炎受累鼻窦窦口多数明显扩大,邻近正常结构受压移位或消失,④受累鼻窦窦壁骨质增厚硬化,可见骨质吸收或破坏。结论:鼻窦窦腔软组织影内线团状、斑点状或云絮状钙化是霉菌性鼻窦炎的较具特征性的CT表现,CT对诊断霉菌性鼻窦炎具有较高的诊断价值。     

老年霉菌性鼻窦炎的诊断及鼻窥镜治疗

目的:探讨老年霉菌性鼻窦炎的临床特点。方法:回顾21例老年霉菌性鼻窦炎的临床资料,对其临床表现、CT检查特点及治疗方法进行分析。结果:本组病例具有不典型的临床表现,病变多发生于上颌窦,具有典型的CT影像学特征,经鼻窥镜手术治疗后1年未见复发。结论:老年霉菌性鼻窦炎具有临床症状不典型,CT诊断价值较高以及鼻窥镜手术治疗效果佳等特点。     

非侵袭性霉菌性鼻窦炎诊断与鉴别诊断

抗生索和激素的广泛应用以及CT检查应用普及，近年霉菌性鼻窦炎（fungalsinusitis，FS）的发病率有逐逝增多的趋势。收集近年收治的22例非侵袭性霉菌性鼻窦炎患者临床资料，就其发病机制、诊断和鉴别诊断进行探讨。     

CT诊断霉菌性上颌窦炎29例临床分析

目的 探讨CT检查对霉菌性上颌窦炎的诊断价值。方法 回顾性分析29例经手术病理证实的霉菌性上颌窦炎的CT表现。结果 多数病变累及一侧上颌窦，CT显示上颌窦内不均匀高密度影，其间可见斑点、斑块状钙化；骨质改变主要为上颌窦窦壁增厚、上颌窦内侧壁骨质吸收或缺损。结论 CT能准确显示副鼻窦炎病变的范围和程度，可作为首选影像学检查手段。     

真菌性鼻窦炎19例诊治体会

目的:通过回顾分析19例真菌性鼻窦炎的临床资料,以提高该病的诊断和治疗水平。方法;对收治的19例真菌性鼻窦炎患者作鼻窦CT检查和鼻内镜检查,并行相应手术治疗。结果:所有病例均为单侧鼻窦发病,其中病变单纯累及上颌窦者12例、单纯累及筛窦者2例、单纯累及蝶窦者1例,有3例同时累及上颌窦和筛窦,有1例同时累及上颌窦、筛窦和蝶窦。有15例(78.9%)窦腔软组织团块影中可见斑点状钙化灶,5例窦腔有不同程度的骨质吸收和破坏。术后随访2年,有3例复发。结论:真菌性鼻窦炎好发于上颌窦,多为单侧鼻窦发病,CT具有较高的诊断价值,手术具有较好的治疗效果。     

霉菌性鼻窦炎的CT表现及其病理学基础

【目的】探讨霉菌性鼻窦炎CT表现及病理学特点,以提高对本病的认识和诊断水平。【方法】回顾性分析28例经手术病理证实的霉菌性鼻窦炎,其中病变累及单侧上颌窦者17例,累及一侧上颌窦及同侧筛窦者5例,累及一侧上颌窦及同侧筛窦、鼻腔者3例,累及双侧上颌窦者3例。【结果】霉菌性鼻窦炎CT表现主要为：病变窦腔内软组织影充填22例,病灶内斑点、条片样钙化26例,窦腔骨壁增厚20例,窦腔缩小16例,骨壁破坏5例。病理表现为被覆假复层纤毛柱状上皮黏膜组织中有较多炎性渗出物、坏死物及淋巴细胞和多形核细胞浸润,可见茵丝、孢子。【结论】病变内钙化影的出现是本病的主要CT表现,是诊断该病较为可靠的依据。     

霉菌性副鼻窦炎的CT表现

目的探讨霉茵性副鼻窦炎的CT特征和鉴别诊断。方法回顾分析18例经手术病理证实的霉菌性副鼻窦炎的CT表现。结果单侧副鼻窦发病14例,双侧副鼻窦发病4例,病变主要在上颌窦14例,累及同侧筛窦9例、蝶窦3例、额窦3例,病变侵犯后鼻孔4例。霉茵性副鼻窦炎的CT表现主要为：病变窦腔软组织阴影充填呈铸形改变,病灶内出现点状、条状钙化灶,窦腔骨壁增厚使窭腔缩小。结论霉菌性副鼻窦炎的CT表现具有窦腔缩小,窦腔密度不均增高及点状,条状钙化等特征,CT可作出正确诊断。     

鼻内镜下真菌性上颌窦炎的术式选择及疗效评估

目的鼻内镜下采用3种不同入路手术治疗真菌性上颌窦炎并对其临床疗效进行观察,为临床个体化治疗真菌性上颌窦炎提供参考。方法以该院2016年1月-2017年12月收治的84例非侵袭性真菌性上颌窦炎的手术患者作为研究对象,术前常规行鼻内镜检查和鼻窦CT检查,根据病变的部位范围选择手术方式,将患者分为3组:A组30例,行鼻腔外侧壁保留黏膜瓣的下鼻道入路;B组20例,行上颌窦自然口入路手术;C组34例,行联合入路手术。结果 84例患者均治愈,血涕、面部胀痛、头痛或鼻腔异味症状逐步消失,鼻内镜复查见术腔愈合好,上皮化良好,各鼻道无异常分泌物,术腔病变无残留,无鼻腔粘连、前鼻孔狭窄、鼻泪管损伤或其他并发症。术后6个月复查鼻窦CT无病变残留,下鼻道黏膜瓣愈合良好。结论术前根据病变部位及范围选择手术方式个体化治疗真菌性上颌窦炎,能充分暴露上颌窦窦腔,有效清除病变,避免损伤鼻腔鼻窦的正常结构,达到既微创又能彻底清除病灶的目的。     

110例真菌性上颌窦炎鼻内镜手术的临床分析

目的 探讨真菌性上颌窦炎鼻内镜下手术方式的选择.方法 通过对110例真菌性上颌窦炎鼻内镜下手术的分析,寻找清除上颌窦病灶的好方法.结果 随访6～12个月,一次性治愈107例,一次性治愈率97.3%,复发3例,占2.7%.影响疗效的主要因素是上颌窦腔内病灶清除的彻底性.结论 选择合理的手术方法,尽量扩大上颌窦开口是治疗真菌性上颌窦炎的关键.     

鼻窦真菌球CT和MRI诊断

目的探讨鼻窦真菌球的CT和MRI表现及诊断价值.方法回顾性分析经手术、组织病理学证实的68例鼻窦真菌球的影像学资料.结果发病部位:单个鼻窦发病60例(88.2 %),其中上颌窦最常见,占41例(60.3%),依次为蝶窦12例(17.6%),筛窦6例(8.8%),额窦1例(1.5%);CT表现:受累鼻窦腔内充以软组织影,其中64例(94.1%)中央见点状、不规则细条状或云絮状高密度影,融合成团块状,代表菌丝,窦壁骨质有不同程度增生肥厚,35例(76.1%)上颌窦内壁见骨质吸收破坏;MRI表现:病变T1WI呈等或稍高信号(与脑实质比较,以下相同),T2WI均呈极低信号,增强后均未见强化;病变周围黏膜明显增厚,T1WI多呈等信号,T2WI均表现高信号,有明显强化.结论 CT是目前诊断鼻窦真菌球最佳影像学检查方法,MRI能够显示真菌球范围和帮助鉴别诊断,可作为一种补充影像学检查方法.     

侵袭性上颌窦真菌病10例报告

目的：提高临床对上与颌窦真菌病的诊疗水平。方法：侵袭性上颌窦真菌病10例，均行CT扫描。10例行Caldwell-Lucs's术，均未用抗真菌药物治疗。结果：其骨化缺损呈溶骨性破坏，与良性肿瘤引起的膨胀性骨质缺损不同，而与恶性肿瘤相似，随访6个月－2年无1例复发。结论：CT诊断该病有重要意义，尽早手术探查有利于明确诊断。     

Comparison of Sinus X-rays with Computed Tomography Scans in Acute Sinusitis

Objective: To determine the sensitivity and specificity of sinus x-rays of patients clinically diagnosed as having acute sinusitis. Methods: Thirty consecutive adult, nonpregnant emergency department (ED) patients clinically diagnosed as having acute sinusitis and meeting study criteria were entered into the study. Sinus x-rays were obtained immediately after study entry and sinus computed tomography (CT) scans were done within 72 hours. Radiologic criteria for sinusitis were defined as more than 3 mm of mucoperiosteal thickening (MPT), an air/fluid (A/F) level, or opacification. All films were read in a blinded fashion [CT scans by two radiologists and plain films by two emergency medicine (EM) staff members and the same radiologists]. A third radiologist interpreted CT scans when the initial radiologists disagreed. Results: Sinus CT scans were obtained for 29 of 30 patients. Radiologists interpreted 28 of 29 CT scans identically, with 21 being positive for sinusitis. Sensitivity and specificity of x-rays were 57% and 88%, 62% and 88%, 67% and 75%, and 48% and 100% for the two radiologists and the two EM physicians, respectively. Four ethmoid, five frontal, and five sphenoid sinuses were opacified or had A/F levels on CT scan. No ethmoid, frontal, or sphenoid sinus was interpreted as being opacified or having an A/F level on plain film. Sensitivity and specificity of maxillary sinus opacification or A/F level on x-ray were 70% and 100%, 70% and 100%, 70% and 96%, and 70% and 96% for the two radiologists and the two EM physicians, respectively. Mean concordances (kappa) of x-ray and CT scan interpretations for the four reviewers were 0.34 (range, 0.30–0.39) for the diagnosis of sinusitis and 0.77 (range, 0.74–0.79) for maxillary sinus opacification or A/F level. Conclusion: Sinus x-rays are less sensitive than sinus CT scans for demonstration of radiographic changes consistent with acute sinusitis. Sinus plain films may not be reliable enough to assist with clinical decision making. If severity of patient illness requires diagnostic certainty, more sensitive imaging studies, such as CT scans of the sinuses, should be considered.     

Comparison of B-mode ultrasound and computed tomography in the diagnosis of maxillary sinusitis in mechanically ventilated patients.

OBJECTIVE: To compare B-mode ultrasound with sinus computed tomograph (CT) scan in the diagnosis of sinusitis in intubated patients undergoing mechanical ventilation. DESIGN: Prospective, clinical investigation. SETTING: Medical intensive care unit of a university hospital. PATIENTS: Fifty patients undergoing intubation and mechanical ventilation more than 2 days, with a clinical suspicion of paranasal sinusitis with purulent nasal discharge. INTERVENTIONS: One hundred paranasal sinuses were examined. A paranasal CT scan and a B-mode ultrasound were performed the same day. Radiologic maxillary sinusitis (RMS) was defined as complete opacification of the sinus or as the presence of an air-fluid level. Absence of RMS was defined as normal sinus or as the presence of mucosal thickening. Important RMS was defined by total opacity or air-fluid level larger than half of the sinus area. Moderate RMS was defined by air-fluid level inferior than half of the sinus area. For ultrasonographic procedure, the image defined as normal was an acoustic shadow arising from the front wall. Two levels of positive echography were described: 1) a moderate lesion was defined as the visualization only of the hyperechogenic posterior wall of the sinus; 2) an important lesion was defined as the hyperechogenic visualization of posterior wall and the extension by the internal wall of the sinus outlining the hypoechogenic sinus cavity. MEASUREMENTS AND MAIN RESULTS: Sensibility, specificity, positive predictive value, and negative predictive value of B-mode ultrasound compared with CT were, respectively: 100% (95% confidence intervals [95% CI] = 94.9-100.0), 96.7% (95% CI = 82.8-99.9), 98.6% (95% CI = 92.4-99.9), and 100% (95% CI = 88.1-100). The concordance between a moderate B-mode ultrasound lesion and a moderate RMS on CT, and between an important B-mode ultrasound lesion and an important RMS on CT, assessed using kappa statistics was 93%. The concordance between B-mode ultrasound's results and CT's results assessed using weighted kappa statistics was 97%. CONCLUSION: B-mode ultrasound may be proposed first-line in a ventilated patient with suspicion of maxillary sinusitis.     

Occult maxillary sinusitis as a cause of fever in tetraplegia: 2 case reports

Common causes of fever in tetraplegia include urinary tract infection, respiratory complications, bacteremia, impaired autoregulation, deep vein thrombosis, osteomyelitis, drug fever, and intra-abdominal abscess. We report 2 acute tetraplegic patients who presented with fever of unknown origin. After extensive work-up, they were diagnosed with occult maxillary sinusitis. A search of current literature revealed no reports of sinusitis as a potential source of fever in recently spinal cord--injured patients. Patients with tetraplegia, especially in the acute phase of spinal cord injury, often undergo nasotracheal intubation or nasogastric tube placement, which may result in mucosal irritation and nasal congestion. All of the previously mentioned factors, in combination with poor sinus drainage related to supine position, predispose them to developing maxillary sinusitis. The 2 consecutive cases show the importance of occult sinusitis in the differential diagnosis of fever in patients with tetraplegia.