|ECR 2019 / C-3083|
|Arrested pneumatization of the sphenoid sinus in four symptomatic patients: principal diagnostic elements, pitfalls and differential diagnosis.|
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) :
- 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:
- 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).
- chondrosarcoma (figure 14);
- sphenoidal lymphoma (figure 15);
- multiple myeloma/plasmocitoma (figure 16);
- metastasis (figure 17, 18).
- fungus ball (figure 19);
- osteomyelitis (figure 20, 21).
- thalassemia major (figure 22).