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ECR 2019 / C-3083
Arrested pneumatization of the sphenoid sinus in four symptomatic patients: principal diagnostic elements, pitfalls and differential diagnosis.
Congress: ECR 2019
Poster No.: C-3083
Type: Educational Exhibit
Keywords: Education and training, Developmental disease, Normal variants, eLearning, Education, MR, CT, Head and neck, Ear / Nose / Throat, Anatomy
Authors: M. Pietragalla, M. Bartolucci, F. Giuntoli, G. B. Verrone, C. Nardi, M. S. Squadrelli, M. Trovati, V. Miele, S. Colagrande; Florence/IT
DOI:10.26044/ecr2019/C-3083

Findings and procedure details

 

Main imaging diagnostic features of arrested pneumatization of the sphenoid sinus are showed (figure 2-6).

 

CT is the best imaging modality for diagnosis (Welker's criteria) [7]:

  • a non-expansile solid lesion;
  • sclerotic margins without cortical breach; 
  • internal curvilinear calcifications; 
  • foci of fat with variable degrees of loss of bone trabecolae.

MRI features that allow to distinguish arrested pneumatization from other middle skull base pathologies are:

  • increased T1-w and T2-w signal intensity;
  • fat-sat saturation;
  • no significant contrast enhancement.

The main differential diagnoses include:

 

   Pseudolesions:

  • fibrous dysplasia (figure 7);
  • ossifying fibroma (figure 8);
  • osseous angioma (figure 9);
  • mucocele (figure 10).

   Notocordal remnants phatology:

  • chordoma of the clivus (figure 11);
  • ecchordosis physaliphora (figure 12, 13).

   Neoplasms:

  • chondrosarcoma (figure 14);
  • sphenoidal lymphoma (figure 15);
  • multiple myeloma/plasmocitoma (figure 16);
  • metastasis (figure 17, 18).

   Infectious diseases:

  • fungus ball (figure 19);
  • osteomyelitis (figure 20, 21).

   Miscellaneous:

  • thalassemia major (figure 22).
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