Mucoceles of the sphenoid sinus

Based on 5 personal cases, the authors conducted a study of sphenoid mucocele, based notably on the results of CAT-scanning. This is the key step in diagnosis. Indeed, it makes it possible to determine the origin of the mass, and its growth, and lysis or even consolidation of bone walls. Magnetic resonance should supply valuable information on the inflammatory nature of the mass, its relationship with the pituitary and chiasma, as well as the images on a sagittal section. The studies conducted to date in general show a different presentation of the tumors in comparison with mucoceles. Because of the latent character of mucoceles they are often diagnosed at a late stage on signs of local involvement.     

Mucoceles of the sphenoid sinus

PURPOSE: Mucoceles of the sphenoid sinus represent 1-2% of all paranasal sinus mucoceles. The aim of this paper is to report our experiences in patients with mucoceles of the sphenoid sinus. PATIENTS AND METHOD: In a period of 4 years, we observed six patients in whom a mucocele of the sphenoid sinus was suggested pre- or intraoperatively. Symptoms and signs included headache, visual loss and palsies of the III and VI cranial nerve. All patients were investigated by MRI and/or CT. Imaging findings were compared with operative and/or histological findings. RESULTS: In three cases there were simple mucoceles, in one case we found a tumour (nasopharyngeal carcinoma) associated mucocele and in two cases, malignant tumours (carcinoma, chordoma) imitated a mucocele. The diagnosis of simple mucoceles was no problem at all by imaging. Difficulties made the two malignant tumours and the tumour associated mucocele. In the first two cases, repeated histological samples were necessary to make the final diagnosis. CONCLUSION: Mucoceles of the sphenoid sinus should be investigated and handled very carefully with regard to differential diagnoses and tumour associated cases.     

Pneumosinus dilatans of the sphenoid sinus

Four cases of pneumosinus dilatans of the sphenoid sinus are reported, supplementing the eight cases previously reported in the literature. This rare entity is characterized by expansion of a paranasal sinus that contains only air. In one patient, severe visual loss due to compression of the optic canal by the adjacent enlarged sinus was seen. Galactorrhea occurred in one patient, and three of the four patients reported headaches. There was dehiscence of the sinus roof in two cases, which apparently resulted in a cerebrospinal fluid fistula in one. Previous reports of this entity are reviewed, and the radiographic findings and clinical presentations are discussed. It is proposed that the term "pneumosinus dilatans" be used to describe all dilated, air-filled sinuses with outwardly bulging walls when the primary cause is uncertain.     

Mucous cyst of the sphenoid sinus

Sphenoid sinus mucous cysts are rare, benign, expansile masses, which can form mucoceles if the entire sinus is filled. Due to their close proximity to numerous important anatomical structures, they can cause a variety of different symptoms. The incidental finding of a sphenoid sinus mucous cyst during cephalometric radiology for orthodontic analysis is reported.     

Imaging the sphenoid sinus: pictorial essay

This paper focuses on the spectrum of sphenoid sinus lesions that may be seen radiologically and the mapping of disease extent. Imaging plays a central role in the assessment of sphenoid sinus disease. Although primary sphenoid sinus disease is uncommon, this sinus is nevertheless affected secondarily by a variety of pathological processes.     

Aspergillosis of the sphenoid sinus simulating a pituitary tumor

Summary Sphenoidal aspergillosis is an unusual cause of sella turcica enlargement. Pituitary abscess secondary to Aspergillus had been reported. In the present case, a woman with sphenoid sinus aspergillosis mimicked a pituitary tumor. This patient survived her infection with intact pituitary function following a transsphenoidal approach. No postoperative amphotericine-B and 5-fluorocytosine were necessary. CT scan revealed a mass occupying the sphenoid sinus extending to the sella turcica. Factors that should alert the clinican to the presence of a sphenoidal and pituitary abscess in a patient with sella turcica enlargement are prior episodes of sinusitis, meningitis and immunosuppression and, as in the present case, hyperglycemia.     

“Unusual” MRI appearance of sphenoid sinus mucocele

Summary The authors report a case of sphenoid sinus mucocele which exhibited unusual MRI features. However a review of the literature shows that these lesions may present with different MRI appearances probably related to the variability of the cyst content. Further series are needed for a better definition of the MRI behaviour of the lesions.     

Capillary hemangioma of the sphenoid sinus with intrasellar and parasellar extensions

Capillary hemangiomas are benign vascular tumors usually diagnosed in infancy and involving skin and soft tissues. We report a rare case of an adult capillary hemangioma of the left sphenoid sinus extending into the intrasellar and parasellar regions. A 71-year-old woman presented with complaints of headaches and diplopia. Magnetic resonance imaging revealed a T2-hyperintense mass-like lesion involving the left posterior ethmoid and sphenoid sinuses and left cavernous sinus, that had extended into the intrasellar and parasellar regions. Dynamic contrast-enhanced computed tomography revealed enhancing vessel-like structures within the lesion during the arterial phase, which were observed to expand further in the late phase of the examination. This characteristic feature indicated increased vascularity, suggesting the presence of a capillary hemangioma. The patient underwent endoscopic resection via the endonasal transpterygoid approach, and the lesion was diagnosed histopathologically as a capillary hemangioma. To aid diagnosis and clinical management, radiologists should be aware of the imaging findings related to capillary hemangiomas.     

Antrochoanal polyp originating from sphenoid sinus causing acute dysphagia

Antrochoanal polyps are not uncommon in childhood and adolescence. Usually they arise from the maxillary sinus, but they also can arise from the turbinates or other sinus cavities including the sphenoid sinus cavity. We present such a case to underscore this less common site of origin of sphenochoanal polyps.     

Acromegaly due to an ectopic pituitary adenoma in the sphenoid sinus

An ectopic pituitary adenoma, exclusively involving the sphenoid sinus, associated with a normal size pituitary gland and an empty sella is a rare clinical entity. Only four cases have been found in the literature. We describe the case of a 47-year-old woman with clinical and biochemical acromegaly. Computed tomography (CT) appeared to show expansion of the sellar floor inferiorly into the sphenoid sinus, and magnetic resonance imaging (MRI) demonstrated an empty sella and a mass lesion confined to the sphenoid sinus. The tumor was totally resected by taking a transnasal endoscopic approach and the dura mater of the base of the pituitary fossa was confirmed intact.     

Paraganglioma of the sphenoid sinus: case report and review of literature

We report a case of a 41-year-old woman who presented with occasional hemoptysis and hoarseness. Imaging showed a mass primarily in the sphenoid sinus but also extending into the right posterior ethmoid sinus and nasopharynx. Histology showed this mass to be a paraganglioma. We describe its computed tomography and magnetic resonance imaging findings, and we discuss the differential diagnosis and treatment.