GeneraP Kenneth

B. Robinson,

R HISTORY A 34-year-old

multiple

MD

black

man

episodes

#{149} Claudia

with

of trauma

D. Fosket,

a history

to the

MD

were

lected

obtained.

CT images

A Waters are shown

left supra-

view (Figs

and

Fraccola,

into the anterior and cells, with destruction

of

cea.

A fine

fat plane

MD

posterior ethmoid air of the lamina papyrawas

preserved

between

the mass and the medial rectus muscle, which was not enlarged (Fig 2c). A soft-tissue mass obliterated the left nasal cavity,

orbital region and whose left eye had been enucleated for tumor presented to the emengency room with left supraonbital swelling of 4 months duration, unresponsive to antibiotic therapy. Facial radiographs and computed tomographic (CT) scans of the paranasal si-

nuses

#{149} PbilipJ.

with and

erosion extended

of the medial left into the maxillary

antral wall, antrum.

se-

1-3).

. FINDINGS The Waters view (Fig 1) demonstrated irregularity of the walls of the frontal sinus, 5ccondary to old injury; erosion of the superomedial left orbital rim; and sclerosis of the superolateral

left

opacification

of the

orbital

rim.

There

was

left nasal

canal

and

left

ethmoid and maxillary sinuses. CT scans (Fig 2) showed a soft-tissue mass in the left frontal sinus that extended into the left preseptal region, the anterior cranial fossa, and the left orbit. The prosthetic globe was displaced laterally. The mass extended

Index

terms:

Mucocele,

RadioGraphics I

From

the c

732

1988 RSNA,

the

1990; Department RSNA 1990

#{149} RadioGrapbks

scientific

23.255

Paranasal

#{149}

sinuses,

CT,

23.121

Figure

1

#{149} Paranasal

1.

sinuses,

Waters

view.

neoplasms.

23.3.

23.255

10:732-734 of Radiology assembly.

U

and

Nuclear

Received

Robinson

Medicine, and

accepted

et al

Rochester October

General 27,

1989.

Hospital.

1 425

Address

reprint

Portland requests

Ave.

Rochester, to

NY

1 462

1 . From

K.E.R.

Volume

10

Number

4

Figures tamed ment

2, 3. (2) with contrast and

photographed

tissue windows. photographed

July

1990

Robinson

et al

CT scans enhance-

U

ob-

at soft-

(3) CT scans at bone windows.

RadioGrapbics

#{149} 733

DIAGNOSIS:

Frontal

pyocele

with

nasal

pol-

yposis

is eroded, and medial

a thin fat plane rectus muscle

Fungal DISCUSSION At surgery, a large frontal pyocele that cxtended into the left orbit and ethmoid air cells was discovered. The left nasal canal and maxillary antrum were filled with inflammatory polyps. The differential diagnoses for U

the mass plasm, inverted

include

Mucoceles process

disease

and

cell

carcinoma

are the most

to involve

They

result

ostium

the

from

expansile

obstruction

pressure necrosis Trauma, with

mucoid

of the sinus; if left unchecked,

and bone erosion resultant alteration

(1 ,2). of the

has been considcause of mucosuch cases occur mucocele is usualinfected and be-

come

enhance

Pyoceles

the

invade

the fat plane

remaining

orbital

space.

of the medial nectus muscle and frequently occurs due to direct

by the

organism.

The

demonstration

of focal or diffuse areas of increased attenuation on unenhanced CT scans suggests fungal infection (5 ,6) Mycetomas reportedly demonstrate weighted

decreased magnetic

very decreased ed images (7). U

1

signal intensity on Ti resonance images and

signal

intensity

-

on T2-weight-

REFERENCES Vashist 5, Goulatia

RK,

evaluation sinuses.

Dayal

Y, Bhargava

of mucocele BrJ

Radiol

S.

of the

1988;

58:959-

Som PM, ShugarJ. Antral mucocele: look.J Comput Assist Tomogn 1980;

a new 4:484-

963. 2.

488.

3.

HcsselinkJR, Weber AL, New PFJ, Davis KR, Roberson GH, Taveras JM. Evaluation of mucoceles of the paranasal sinuses with computedtomography. 400.

penipher-

ally on CT scans. An aggressive mucocele on pyocele can destroy bone and appear malignant (3) The effect of the mass on the globe,

.

Radiologic paranasal

thin-

normal ostial configuration, ered a major predisposing cele. Nearly two-thirds of within the frontal sinus. A ly sterile but may become

a pyocele.

Enlargement optic nerve invasion

will

into

of a sinus of a mucous

the slow-growing

leads to expansion of the walls; and,

infection

extend

.

or

sinuses.

distension

Eventually,

neo-

common

paranasal

local

on progressive

gland. mass ning

fungal

such as squamous papilloma.

and

between mucocele is preserved (4).

4.

Radiology

1979;

133:397-

Perugini 5, Pasquini U, Menichelli F, et al. Mucoceles in the paranasal sinuses involving the orbit: CT signs in 43 cases. Neuroradiolo-

.

optic with mass.

tunes, When

orbit, laterally.

nerve, CT,

gives

and

extraocular clues

muscles,

to the

nature

as seen

of the

Mucoceles displace soft-tissue strucwhile malignant lesions invade them. a mucocele expands into the medial the medial nectus muscle is displaced Even

though

the

lamina

papyracea

gy 1982;

5.

6.

scanning

7.

23:133-139.

Kopp W, Fotten R, Steiner H, Beaufort F, Stammbengen H. Aspergillosis of the paranasal sinuses. Radiology 1985; 156:715-7 16. Centeno RS, Bentson JR, Mancuso AA. CT in rhinocerebral

ing. Radiology

734

U

Ra4ioGrapbics

.

Robinson

et al

mucormycosis

and

aspengillosis. Radiology 1981; 140:383-389. Zinneich SJ, Kennedy DW, MalatJ, et al. Fungal sinusitis: diagnosis with CT and MR imag1988;

169:439-443.

Volume

10

Number

4