ENT Appointment CT & MRI Results for sinus issues

Just got back from my ENT’s office to sit down and review both the MRI and CT scans that were done last week with my ENT’s NP.

To summarize:

I have a left frontal osteoma with chronic sinusitis.  The osteoma is roughly the size of a golf ball.  Both Maxillary and ethmoid sinuses have a pretty bad infection to which they prescribed Doxycycline for a few weeks.  From a surgical standpoint, the osteoma, or “Fred” will be removed either via endoscopic sinus surgery or craniotomy.  Currently I would be looking at surgery roughly into a May timeframe, so that date is TBD.

Another finding is that I most likely have a CSF leak along the frontal sinus or in my ethmoid skull base.  This may require a co-surgeon’s assistance with a neurosurgeon.  Another finding was a possible left maxillary papilloma which will require a biopsy, and clearing of the margins.

Surgery will most likely include a septoplasty, bilateral turbinate reduction, bilaterally maxillary antrostomy, left total ethmoidectomy, and left frontoal sinusotomy to remove the osteoma.  The surgery will take about 2 hours complete, and the recovery from the surgery will be roughly 2 weeks.

She believes most of my issues of balance, blurred vision, seeing stars are mostly due to the above problems, and the surgery should alleviate everything.

I have a followup appointment with my ENT to go more into detail about the upcoming surgery, expectations, procedure, etc next Friday on the 12th.

Big thanks to my alternative life partner for shuttling me to/from my appointment.

Below are the results/findings of both the CT and MRI scans done last week

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CT Results 3/20/2019:


EXAM: CT of the sinuses, stealth protocol

INDICATION: Frontal sinus osteoma.  Mastoiditis.  Immunosuppression.

COMPARISON:  MRI of the brain same day

TECHNIQUE:  Stealth Protocol Performed

FINDINGS:  There is a calcified nodule in the left frontal sinus.  This fills the medial aspect of the left frontal sinus and occludes the left frontal drainage pathway.  There is a small pneumatized portion of the superior aspect of the frontal sinus.

The sclerotic nodule has eroded through the posterior wall of the left frontal sinus and upper aspect of the left frontal drainage pathway and this is seen clearly within the study.  There is no pneumocephalus.  The region of wall thinning or erosion measures 1.2cm in transverse by 1.5 cm in SI dimension.  The calcified lesion measures maximally 2.3 cm in AP x 2.6 cm in SI x 2.2 cm in transverse dimension.

There is also a soft tissue thickening or mucosal thickening in the left anterior ethmoid air cells.  There is occlusion of the left middle meatus.  There is soft tissue thickening in the left middle meatus measuring 1.4 cm in AP dimension.

The left maxillary sinus is nearly completely opacified.  The left maxillary sinus medial and superior wall is expanded and demineralized or eroded.  The left ucinate process is demineralized or eroded.

The posterior left ethmoid air cells and sphenoid sinus are well aerated.

The right frontal, ethmoid, maxillary and sphenoid sinus and drainage pathway are patent.

There is deviation of the nasal septum to the right.  There is mild nasal turbinate enlargement most pronounced in the left inferior turbinate.

The bone over the superior margin of the fovea ethmoidalis is very thin bilaterally and me dehiscent.  There is no meningocele seen.

The bone over the more posterior fovea ethmoidalis is also thinned bilaterally.

The roof of the sphenoid sinus is also very thin bilaterally without meningcoele.

The maxilla is normal.  The brain and ventricles are normal.

The mastoid air cells are well aerated.  There is no middle ear lesion.  The cochlea is normal.  The skull base is normal.

IMPRESSION:


1.  The left frontal sinus lesion is consistent with the provided history of frontal osteoma.  There is bony erosion or bony defect in the posterior wall of the left frontal sinus and drainage pathway and this may represent the anatomic site for (CSF) cerebrospinal fluid leak if applicable.

2.  There is marked thinning of the bone over the superior sphenoid, fovea ethmoidalis bilaterally and this could predispose to CSF leak.  This may be further characterized with direct coronal imaging through these regions.  There is no meningocele or pneumocephalus seen and the cribriform plate is intact.

3.  There is left frontal, ethmoid and sphenoid sinusitis with occlusion of the middle meatus consistent with the middle meatal pattern of sinusitis.  The left maxillary sinus is enlarged consistent with a mucocele.  There is also bony erosion or dehiscence of the medial left maxillary sinus wall.  The posterior left maxillary sinus wall also bulges.  There is no posterior left maxillary sinus wall dehiscence seen.

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MRI Results 3/20/2019:

EXAM:  MRI of the Brain with and without contrast

INDICATION:  Frontal sinus osteoma and mastoiditis.

TECHNIQUE:  Pre- and post-contrast protocol performed.  CSF leak protocol performed.  Contrast dose 17 cc of Dotarem.

FINDINGS:  A CT scan was performed from the same time for comparison.  The crebral cortex is normal in signal intensity.  The corpus callosum and white matter structures are normal.  The ventricles are normal.  The suprasellar, prepontine cistern and foramen magnum are normal.  The midbrain is normal.  The pons and medulla are normal.  The cerebellar hemispheres are normal.

On the CT scan from the same date there is a calcified lesion in the left frontal sinus occluding the frontal drainage pathway.  This region is relatively hypointense on the T2 sequence and FLAIR sequence.  The lesion mildly enhances after contrast.

There is opicification of the left frontal sinus, there is complete opacification of the left ethmoid air cells.

The left maxillary sinus is completely filled with fluid and mucosal thickening and there is soft tissue enhancing tissue in the frontal drainage pathway, left anterior ethmoid air cells and in the middle meatus.

The medial margin of the left maxillary sinus is expanded into the left middle meatus just above the axial level of the left inferior turbinate.

The floor of the orbit is intact.  There is no extension of the enhancement in the retroantral fat pad.

The posterior and lateral margin of the left maxillary sinus is convex.  There is nonenhancing fluid in the left maxillary sinus.  There is also a nonenhancing polypoid region in the left inferior maxillary sinus.

The rim-enhancing lesion is located in the inferior left maxillary sinus and measures 1.8 cm and is round.  This has an enhancing wall and the central portion of this does not enhance.  This extends to to the alveolar margin of the left side of the maxilla.

The cribriform plate is normal.  There is dural enhancement present along the left posterior margin of the left frontal sinus lesion.  This is observed within the study.  Also on the cisternogram sequence there is minimal fluid present along the posterior margin of the left frontal sinus osteoma medially seen within the study.

There is fluid around the margin of the left frontal sinus lesion.  The bone over the anterior aspect of the left fovea ethmoidalis is also very thin and there is high signal intensity in this region seen on the cisternogram sequence.

The roof of the sphenoid sinus and right fovea ethmoidalis is intact.

IMPRESSION:


1.  The left frontal sinus lesion is sclerotic and calcified on the accompanying CT scan and this is consistent with an osteoma.  The bone over the posterior margin of the left frontal sinus is either eroded or dehiscent and may be the site of the CSF leak and there is mild dural enhancement within this region.  Also the bone over the anterior left fovea ethmoidalis is very thin and my be dehiscent and this could represent a potential site for a CSF leak.  Since the bone over the posterior margin of the osteoma is either thin or dehiscent, this could predispose to CSF leak if this area is resected.

2.  There is left frontal, ethmoid and maxillary sinusitis consistent a middle meatal pattern of sinusitis.  The left maxillary sinus is expanded and the bone over the medial margin of the left maxillary sinus is eroded or demineralized and this is consistent with a mucocele.

3.  There is a rim enhancing lesion in the inferior left maxillary sinus.  This may represent a polyp.  This could represent a periapical cyst or odontogenic cyst less likely.  On the CT scan there had been a prior dental extraction in the left side of the maxilla of the left first and second maxillary molars.  There is no oroantral fistula detected.  At the same time recommend direct inspection of the maxilla in this region and/ or dental radiography.

4.  There is no intracranial manifestation of CSF hypotension.  There is no diffuse dural enhancement and the cisterns are normal.