Male, 64 years old, with chronic polypoid sinusitis with lamina papyracea and skull base erosion, presenting with eye pain and severe headaches, status post FESS and Lothrop procedure. As on the prior examinations, extensive heterogeneous polypoid opacification is seen involving the frontal sinuses, frontoethmoidal recesses, and the ethmoid cavities. Mucosal thickening is also seen in the sphenoid sinuses, right side more than left. The opacifying material in the left ethmoid cavity is relatively T2 hypointense which can indicate inspissated secretions or fungal elements.Postoperative findings are seen compatible with both the prior reported functional endoscopic sinus surgery and Lothrop procedure. The maxillary sinuses are clear with only trace peripheral mucosal thickening and the neo-antra are widely patent. Osseous thinning and/or deficiency of the laminae papyraceae and right ethmoid roof is better appreciated on prior CT. The polyps encroach upon the orbits, right side more than left. In addition, polypoid material seems to pass through the right ethmoid roof and approaches close to the right gyrus rectus, but without gyral edema.Portions of the brain are not visualized as the examination was tailored for assessment of the paranasal sinuses and the skull base/orbits. However, no areas of parenchymal edema or mass effect are detected. No pathologic parenchymal or extra-axial enhancement is seen. Scattered foci of white matter T2 hyperintensity are demonstrated, a nonspecific finding which likely reflects chronic microvascular ischemia. The ventricles are normal in size and morphology.
Evidence of sinonasal surgery is seen with extensive persistent polypoid opacification involving the frontal sinuses, frontoethmoidal recesses and ethmoid cavities. Some of the opacifying material is T2 hypointense which can indicate inspissated secretions or fungal elements.Osseous thinning and deficiency involving the laminae papyraceae and the right ethmoid roof is better assessed on prior CT. Polypoid tissue does encroach upon the right orbit more than the left, and a small amount of polypoid tissue encroaches through the right ethmoid roof adjacent to the right gyrus rectus. No brain parenchymal edema is identified.