Radiology Case Quiz Case 3

Abstract

A 34-YEAR-OLD WOMAN PRESENTED WITH right-sided nasal obstruction, intermittent discolored drainage, and facial pressure centered over the right cheek region. She had undergone multiple endoscopic sinus operations, most recently 4 years earlier, as well as rhinoplasty because of functional concerns. Her symptoms of right-sided mucopurulent drainage and pressure temporarily improved after courses of systemic antibiotic therapy. Her symptoms would recur, however, and she had undergone monthly courses of broad-spectrum and culture-directed systemic antibiotic therapy over the preceding 2 years. A review of systems was otherwise noncontributory. Physical examination revealed minimal right-sided internal and external nasal valve collapse. Rigid sinonasal endoscopy using a 30° endoscope demonstrated partially resected middle turbinates bilaterally, with widely patent maxillary antrostomies. The patient’s sinonasal cavities were patent and without signs of significant mucosal inflammation or mucopurulence. The results of the rest of her head and neck examination were normal. Previous endoscopic evaluations had revealed mucopurulence emanating from the right maxillary antrostomy that cleared temporarily with systemic antibiotic therapy. A computed tomographic scan without contrast (Figure 1 and Figure 2) was performed to further evaluate the sinonasal cavities and to try to determine the pathogenesis of the recurrent maxillary infections. The endoscopic view during surgery is shown in Figure 3, and the specimen is shown in Figure 4. What is your diagnosis?