69-year-old female with history of sinus pressure and pain and gait problems. CT head: There is asymmetric atrophy of the left temporal lobe appearing similar to prior. There is mild periventricular and subcortical white matter hypoattenuation. No evidence of acute intracranial hemorrhage. Mildly advanced volume loss for age. No abnormal mass or mass effect. The ventricles and sulci are symmetric. The basal cisterns are intact. The paranasal sinuses will be discussed below.CT Sinus: There is extensive mucosal thickening within the right maxillary sinus, right ethmoid air cells, and nasal passage with a large amorphous density of unclear etiology. There is relatively mild mucosal thickening of the left ethmoid air cells and right frontal sinus. There is a large nasal septal defect which seems to be filled with amorphous soft tissue material of uncertain etiology. Right cheek lesion is no longer visualized. The lamina papyracea are intact. The sphenoid sinuses communicate widely with the nasal cavity which may be congential or postsurgical in etiology. The right maxillary infundibula and frontoethmoidal recesses are opacified. The left ostiomeatal complex and frontoethmoidal are unremarkable. The mastoid air cells are clear.
1. No acute intracranial hemorrhage, mass or mass effect.2. Stable chronic small vessel ischemic disease and left temporal lobe atrophy.3. Severe sinus disease as above predominantly affecting the right paranasal sinuses.4. Large nasal septal defect with amorphous soft tissue density which may represent secretions or iatrogenic material. Correlation with clinical exam is recommended.