Clinical question: Patient with history of non-Hodgkin's lymphoma in maxillary sinus. Signs and symptoms: Non-Hodgkin's lymphoma. Enhanced CT of maxillofacial:In comparison with the prior examination there is significant interval reduction in the amount of fluid/soft tissue density within bilateral maxillary sinuses and anterior ethmoids as well as left frontal sinus. There is suggestion of bilateral endoscopic functional sinus surgery of maxillary sinuses. On the current exam there is only very minimal mucosal thickening of the right maxillary sinus without any detectable tumor. There is mucosal thickening at the level of sinonasal window with occlusion.There is also significant improvement of the left maxillary sinus with residual mucoperiosteal thickening throughout the left maxillary sinus and it severely compromised sinonasal window. The frontal sinuses are well pneumatized and no evidence of residual disease. There is evidence of bilateral ethmoidectomy with some residual mucoperiosteal thickening however with interval improvement since prior exam.Images through the nasal cavity demonstrate postoperative changes and no detectable mass. This examination demonstrate no definitive evidence of lymphoma however this can be further evaluated with a dedicated MRI examination of maxillofacial region. Bony structures of the area of the study demonstrate no destructive changes.Few small nonpathologic and non-enhancing bilateral cervical nerve roots in this limited view of upper neck are again identified. Limited view of intracranial content and including cavernous sinuses demonstrate no definitive abnormality.Images through the orbits are unremarkable.40 cc of Omnipaque 350 was utilized for the above study.
1.Significant improvement of paranasal sinuses since prior study with better pneumatization as detailed above.2.Residual mucoperiosteal thickening in bilateral maxillary sinus and with occluded bilateral sinonasal windows as described.3.This examination demonstrates no definitive evidence of tumor however CT scan can miss small tumors as it can appear as mucosal thickening. This area can be better evaluated with a dedicated MRI for tumor.4.No evidence of bony destructive lesion and unremarkable limited view of intracranial content.