X-ray signs of diseases of the nose and paranasal sinuses

Sinus injuries are associated with fractures of the bones that surround them. The fracture gap and displacement of fragments are determined by X-rays or tomograms. Hemorrhage into the damaged sinus is accompanied by its darkening. If air from the sinus penetrates through a crack in its bone wall into the surrounding tissues, then light gas bubbles can be seen on the X-rays against the background of these tissues. The most common fractures are those of the nasal bones, which are characterized by displacement of fragments backwards and downwards. The task of the radiologist is not so much to identify the fracture line, but to establish the degree of deformation of the bony part of the nose before and after reduction of the fragments.

Any replacement of air in the sinus with other tissue (exudate, blood, granulation, tumor) leads to a decrease or disappearance of its lumen and, consequently, to its darkening in the images.

Acute inflammatory lesion of the sinus is expressed in hyperemia, edema and infiltration of the mucous membrane. On X-ray images, a narrow shadow appears in the form of a strip along the edges of the sinus. Transparency of the sinus is increasingly reduced as a result of swelling of the mucous membrane and the appearance of inflammatory exudate. Eventually, X-rays and tomograms reveal an intense homogeneous darkening of the sinus. When the patient is in an upright position, a horizontal level of fluid and gas above it can be seen in this sinus. The transition of the inflammatory process to the bone walls of the sinus is accompanied by their thickening due to periosteal layers or destruction.

In chronic hyperplastic sinusitis, due to thickening of the mucous membrane along the bony walls of the sinus, intense parietal darkening is determined on radiographs and especially on tomograms. Their contour, facing the inside of the sinus, is clear, but usually slightly wavy or uneven. With the development of polypous sinusitis, the parietal darkening becomes uneven and arcuate or cusp-like contours of adenomatous polyps are visible against the background of the deformed lumen of the sinus.

Cysts are observed mainly in the maxillary sinuses. They develop from the mucous membrane and contain a light yellow fluid rich in cholesterol crystals. On radiographs and tomograms, these cysts are distinguished as formations of a round, ovoid or spherical shape, adjacent to one of the walls of the sinus. In order to distinguish a cyst of the maxillary sinus from a retention cyst of dental origin, growing into the sinus from the side of the alveolar process (periradicular or follicular cyst), it is necessary to additionally take dental images. They allow you to establish the relationship of the cyst to the roots of the teeth and the bottom of the maxillary sinus. When differentiating a cyst and a large polyp, it is necessary to take into account clinical and radiographic data, but this is easiest to do with computed tomography or magnetic resonance imaging, since the latter immediately indicate liquid contents in the case of a cyst

Benign and malignant tumors appear in the corresponding sinus as a round, oval or bizarre shadow with smooth or bumpy outlines. Osteoma is very easy to recognize, as it has a bone density and structure. Chondromas give limited darkening with wavy contours; calcareous inclusions can be determined in their thickness. Angiofibromas form soft tissue nodes that can spread far from the nasopharynx into the nasal cavity or paranasal sinus and cause destruction of the bones of the facial and base of the cranium. Cancer and sarcomas that arise in the paranasal sinuses and the bones that make them up quickly lead to destruction of the sinus walls and its intense darkening on images. Computer and magnetic resonance tomography play a special role in their diagnosis.