X-ray signs of diseases of the nose and paranasal sinuses
Last reviewed: 19.10.2021
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Damage to the sinuses is associated with bone fractures, in the environment of which they are. The fracture and displacement of fragments are determined from x-ray images or tomograms. Hemorrhage into the damaged sinus is accompanied by its darkening. If the air from the sinus penetrated through the fracture of its bone wall into the surrounding tissues, then on the X-ray patterns you can see light gas bubbles against the background of these tissues. Most often, there are fractures of the nasal bones, which are characterized by displacement of fragments back and forth. The task of the radiologist is reduced not so much to reveal the fracture line, but how to establish the degree of deformation of the osseous part of the nose before and after the repair of the fragments.
Any substitution of air in the sinus with another tissue (exudate, blood, granulation, swelling) leads to a decrease or disappearance of its lumen and, consequently, to darkening it in the pictures.
Acute inflammatory sinus damage 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 sinus margins. Transparency of the sinus decreases more and more as a result of swelling of the mucous membrane and the appearance of inflammatory exudate. In the end, on the radiographs and tomograms, an intense uniform darkening of the sinus is detected. In the vertical position of the patient in this sinus, the horizontal level of the liquid and the gas above it can be seen. The transition of the inflammatory process to the bony walls of the sinus is accompanied by their thickening due to periosteal layers or destruction.
In chronic hyoeroplastic sinusitis, due to thickening of the mucous membrane along the sinus bone walls on X-rays and especially on the tomograms, intensive parietal darkening is determined. Their contour, turned inside the sinus, is clear, but usually slightly wavy or uneven. With the development of polyposis sinusitis, the parietal darkening becomes uneven and on the background of the deformed lumen of the sinus arched or curly-like contours of adenomatous polyps are seen.
Cysts are observed mainly in the maxillary sinuses. They develop from the mucous membrane and contain a light yellow liquid, rich in cholesterol crystals. On X-rays and tomograms, these cysts are distinguished as a round, ovoid or spherical form adjacent to one of the sinus walls. In order to distinguish the cyst of the maxillary sinus from the retention cyst of dental origin, growing in the sinus from the side of the alveolar bone (foliate or follicular cyst), it is necessary to take additional pictures of the teeth. 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 cysts and large polyps, it is necessary to take into account clinical and radiographic data, but it is most easily done with computer or magnetic resonance imaging because the latter immediately indicate liquid contents in the case of cysts
Benign and malignant tumors appear in the corresponding sinus in the form of a round, oval or fanciful shade with smooth or tuberous outlines. It is very simple to recognize osteoma, since it has bone density and structure. Chondromes give limited obscuration with wavy contours; in their thickness can be determined by calcareous inclusions. Angiofibroma 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 the base of the cerebral cranium. Cancer and sarcomas arising in the paranasal sinuses and their constituent bones rapidly lead to the destruction of the sinus walls and its intensive darkening in the pictures. A special role in their diagnosis is played by computer and magnetic resonance imaging.