Female, 75 years old, with lytic bone lesions and concern for malignancy in the right maxillary sinus/nasal cavity. The bony walls of the right maxillary sinus are thickened and the sinus itself is completely opacified by a combination of peripheral mucosal thickening and central fluid or secretions. As noted on prior CT, a combination of mucosal thickening and secretions projects through the widened ostium into the right nasal cavity. That portion of the tissue which projects into the nasal cavity is markedly hypointense on T2-weighted images (see image 29 series 41), and of intermediate intensity on T1-weighted images. The presumed secretions within the sinus are mildly diffusion restricting, but the thickened mucosa and the intranasal tissue are not. Patchy opacification is seen involving the ethmoid air cells and the right frontoethmoidal recess. Evidence of extensive prior ischemia is seen in the partially visualized intracranial space.
Findings are seen compatible with likely long-standing inflammation of the right maxillary sinus. The sinus is completely opacified by a combination of peripheral mucosal thickening and central inspissated secretions. Thickened mucosa and secretions project through a widened maxillary ostium into the nasal cavity. The tissue occupying the right nasal cavity demonstrates marked T2 hypointensity which can be an indication of fungal elements. This constellation of findings may therefore represent chronic allergic fungal sinusitis with polyp formation. The possibility of a sinonasal malignancy is considered much less likely.