Unilateral opacification of paranasal sinus ct scans

Abstract

Objectives: CT scanning of the paranasal sinuses is a routine investigation for patients with sinonasal symptoms. The presence of unilateral opacification on CT scanning is regarded as suspicious and demands further investigation such as biopsy. We report our recent experience with unilateral opacification on CT. Methods: We reviewed all paranasal CT scans performed in our department from December 2000 to September 2003 to identify those scans with entirely unilateral opacification. Data from these patients were collected that included histology, presenting symptoms, evidence of bony erosion and endoscopic findings. These data were analyzed using Chi-Square and Fisher’s Exact tests where appropriate. Results: Of the 1118 scans performed in this period, we identified 28 patients with unilateral opacification. There were 20 male and 8 female with mean age 59.4 years (range 30 to 89). Twelve (42.9%) had neoplastic disease while 13 (46.4%) had inflammatory disease; no histology was available for 3 (10.7%). Of those with neoplastic disease, 6 (50%) were malignant. Patients with inflammatory disease were significantly more likely to complain of nasal discharge compared to patients with neoplastic disease ( P = 0.009). Likewise patients with neoplasia demonstrated a mass lesion on nasendoscopy more than those with inflammatory disease ( P = 0.01). Of the 6 patients with proven malignancy, 5 had evidence of bony erosion while no patients with benign neoplastic or inflammatory disease had bone erosion. Conclusions: A wide variety of conditions can present with unilateral sinus opacification on CT scanning although in our series the majority were benign. Patients with clinically visible mass lesions were more likely to have neoplastic disease. Bony erosion was only associated with malignant disease. Histological confirmation remains obligatory for diagnosis.