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Approaches to Imaging Issues of Sinus and Nose Congenital lesions can be classified as those presenting with nasal obstruction vs. nasal mass.Pain may also be caused by mucoceles or neoplasms, while paresthesias can be linked to malignancies such as adenoid cystic carcinomaFor instance, osteomas most often arise in the frontal and ethmoid sinuses, juvenile angiofibromas (JAF) arise in the posterior NC at the sphenopalatine foramen, inverted papillomas often arise along the lateral nasal wall, and esthesioneuroblastoma (ENB) typically arises near the CP. Squamous cell carcinoma is by far the most common SN malignancy and most often arises in the maxillary antrum.Mycetoma and allergic fungal sinusitis occur in immunocompetent patients and invasive fungal sinusitis (IFS) occurs in the immunocompromised or poorly controlled diabetics.Well marginated tumors that cause bony remodeling suggest benign tumors, while infiltrative masses with osseous destruction suggest malignant lesions.Because of the anatomy of the PS drainage pathways, predictable patterns of inflammatory disease exist based upon the point of obstruction.Pyriform aperture stenosis and choanal atresia, for example, cause nasal obstruction without a mass.Frontoethmoidal cephaloceles, intranasal gliomas, and nasolacrimal duct mucoceles present with an intranasal mass.For example, obstruction of the MM would lead to disease in the ipsilateral frontal, anterior ethmoid, and maxillary sinuses.Three malignant neoplasms with a predilection for the NC include ENB, lymphoma, and melanoma.

Approaches to Imaging Issues of Sinus and Nose
Congenital lesions can be classified as those presenting with
nasal obstruction vs. nasal mass. Pyriform aperture stenosis
and choanal atresia, for example, cause nasal obstruction
without a mass. Frontonasal cephaloceles, dermoids, and
extranasal gliomas present as extranasal masses.
Frontoethmoidal cephaloceles, intranasal gliomas, and
nasolacrimal duct mucoceles present with an intranasal mass.
MR imaging can be very helpful for evaluating any connection
to the intracranial space.
Rhinosinusitis (RS) is the most common pathology of the SN
region. Acute RS is usually diagnosed clinically and may not
require imaging. Because of the anatomy of the PS drainage
pathways, predictable patterns of inflammatory disease exist
based upon the point of obstruction. For example, obstruction
of the MM would lead to disease in the ipsilateral frontal,
anterior ethmoid, and maxillary sinuses. SER obstruction
might lead to ipsilateral posterior ethmoid and sphenoid
disease. Although uncommon, there are several forms of SN
fungal disease. Mycetoma and allergic fungal sinusitis occur in
immunocompetent patients and invasive fungal sinusitis (IFS)
occurs in the immunocompromised or poorly controlled
diabetics. It is important to note that IFS may appear masslike or as subtle infiltration of fat planes adjacent to the PS
at imaging. Granulomatous disease has a predilection for
involving the nasal septum and turbinates.
There are a wide variety of SN neoplasms. Well marginated
tumors that cause bony remodeling suggest benign tumors,
while infiltrative masses with osseous destruction suggest
malignant lesions. The site of origin may also be predictive of
histology. For instance, osteomas most often arise in the
frontal and ethmoid sinuses, juvenile angiofibromas (JAF)
arise in the posterior NC at the sphenopalatine foramen,
inverted papillomas often arise along the lateral nasal wall,
and esthesioneuroblastoma (ENB) typically arises near the CP.
Squamous cell carcinoma is by far the most common SN
malignancy and most often arises in the maxillary antrum. The
imaging features of adenocarcinomas can be nonspecific, but
they have a predilection for the ethmoid region. Three
malignant neoplasms with a predilection for the NC include
ENB, lymphoma, and melanoma.
Clinical Implications
It is important to note that studies have shown a poor
correlation between symptoms of RS and CT findings. The
diagnosis of RS is ultimately a clinical one. Lesions located
within the NC can be evaluated with endoscopy. Lesions
involving the PS are difficult to evaluate with scopes, so
imaging is important for full evaluation.
Disease of the SN cavities often presents with nonspecific
symptoms, such as nasal obstruction, discharge, and
craniofacial pain. Additional symptoms, such as epistaxis, may
be indicative of a vascular lesion (JAF or ENB). Pain may also
be caused by mucoceles or neoplasms, while paresthesias can
be linked to malignancies such as adenoid cystic carcinoma