Clinical question: Assess for sinus disease/infection. Signs and symptoms: 55-year-old female with MDS and severe facial pain. Concern for invasive sinusitis. Non-enhanced CT of paranasal sinuses:Frontal sinuses, worsening of frontal sinus disease since prior study.Sphenoid sinus, worsening of sinusitis since prior exam.Ethmoid sinuses, significant worsening of the left ethmoid sinus disease since prior exam. Minimal new right posterior ethmoid sinus disease.Maxillary sinuses demonstrate significant interval worsening of left maxillary sinus disease with near complete opacification on the current exam. Complete occlusion of left ostiomeatal unit. Unremarkable right maxillary sinus and with patent right ostiomeatal unit which has remained stable since prior exam.There is thinning of the posterolateral wall of left maxillary sinus with a suspect a small area of bony defect. There is also effacement of fracture plane in the left infratemporal fossa and including the left retromaxillary fat pad. There is also effacement of fascial planes between the masticator muscles at this site. There is edematous changes of the musculature. Comment a follow-up with an enhanced MRI exam for further evaluation.There is no detectable retro-orbital space abnormality on the left however the edematous changes of the left infratemporal fossa extends into the left inferior orbital fissure.Images through nasal cavity demonstrate increased soft tissue density in the posterior aspect of left nasal cavity.Visualized mastoid air cells and middle ear cavities are unremarkable.Above findings were discussed at the time of interpretation with Dr. Scott Siglin pager number 2953.
Interval worsening of sinusitis in particular on the left with extension of edema/inflammatory changes into the left infratemporal fossa with effacement of fascial plane which also extends into the left inferior orbital fissure. Follow up with an MRI is recommended.