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26/3/23, 21:41 Cambodia Tut CT Sinuses | enteducationswansea
This tutorial is about how to read a CT scan of the nose and paranasal sinuses. It is for interest only as you
will not be ordering a CT scan yourself. Some patients come to the clinic with a CT scan in their hands so it is
useful to be able to interpret them a little.
There are some things that you need to know before you start.
Key facts.
1. 40% of people have abnormalities in the sinuses on CT scanning. This means that four out of ten
people without any nasal symptoms or problems with their sinuses have an abnormality when scanned.
2. Rhinosinusitis is diagnosed clinically. This means that we use our knowledge of the disease and our
physical examination skills to make the diagnosis. We do not use a CT scan.
3. A CT scan is used when we are planning surgery as it gives a good view of the anatomy of the
sinuses and shows the surgeon where important structures such as the lamina papyracea and cribriform
plate are.
4. Plain X-rays of the sinuses are no help in making a diagnosis in the majority of patients.
Introduction
A good knowledge of the anatomy of the face, nose and sinuses is essential before trying to understand the
CT anatomy. CT scans can be formatted in any plane: axial, coronal and parasagittal. In practice we use the
coronal scans most but when we operate on the sinuses all views are useful. Review the tutorial on the
physiology and anatomy of the nose before proceeding.
The following sequence of slides shows normal anatomy in the axial plane and then the coronal plane. Once
you understand the radiological appearances of the sinuses we will look at pathology.
Axial Anatomy
Axial CT scan through the forehead Axial CT scan through the root of the nose
Axial CT scan through the orbit Axial CT scan through the cheek
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Coronal Anatomy
Axial CT scan through the palate
Coronal CT through the nose Coronal CT through frontal Sinuses
Coronal CT through the Cribriform Plate Coronal CT through Posterior Nose
Coronal CT through the Orbital Apex Coronal CT through Sphenoid Sinus
Cases with Pathology
Below are examples of CT scans with pathology. It is not usually possible to state what the exact pathology is
by looking at a CT scan and clinical examination with histological study give a better understanding. Don’t be
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26/3/23, 21:41 Cambodia Tut CT Sinuses | enteducationswansea
tempted to make a diagnosis on the scan alone, always correlate the scan with clinical findings.
Contact us
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26/3/23, 21:41 Cambodia Tut CT Sinuses | enteducationswansea
Case courtesy of Dr Fakhry Mahmoud Ebouda
This scan shows a number of interesting features.
The right maxilla and ethmoids are full of a soft tissue which
has variable opacification. The lamina papyracea is broken
down in places and the septum also appear to be eroded.
This is an invasive fungal sinusitis – a rapidly fatal disease if
left untreated.
It is commoner in immunocompromised patients.
Management is with aggressive medical and surgical
treatment.
Summary
Patients may come to see you with CT scans of their sinuses and ask you what is wrong with them.
Remember that you cannot make a diagnosis without a full history and an examination.
Also remember that an abnormal scan does not mean an abnormal patient. Up to 40% of us have abnormal
CTs of our sinuses yet most of us don’t have sinus disease. Treat the patient, not the scan!
CT is used for planning treatment or in cases where a malignancy is a possibility.
Disclaimer
This site is for educational purposes only and as such does not replace clinical judgement. The site contains high-
resolution images, although mobile compatible. For optimum viewing, please switch to a HD ready computer.
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