Learning objectives
Show CT and MR features of arrested pneumatization of the sphenoid sinus
Pointthe main diagnostic elements
List principalpathologies in differential diagnosis
Background
Arrested pneumatization of the sphenoid sinus represents a rare benign variant of skull base development.
In most cases it’s asymptomatic and an occasional finding during CT or MR examinations performed for other reasons,
most frequently neurologic or ENT symptoms.
Otherwise,
in some patients it can cause headache and obstructive symptoms due to alteration of normal mucosal drainage in the paranasal sinuses [1].The physiological process of the pneumatization of the sphenoid sinus begins after about 4 months of life to complete during adolescence.
In fact,
the...
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...
Conclusion
CT is the best technique for the diagnosis of arrested pneumatization of the sphenoid sinus.
If not recognized,
this entity can be mistakenly interpreted for an expansive or infectious pathological process of the middle skull base,
with further not necessary investigations,
procedures and treatments for the patients.
Personal information
Michele Pietragalla(1),MD.
Phone number:+39 055 7947189Fax number: +39 055 431970e-mail:
[email protected]
Maurizio Bartolucci(2),MD.
e-mail:
[email protected]
Federico Giuntoli(1),MD.
Phone number:+39 0572 75667 e-mail:
[email protected]
Giovanni Battista Verrone(1),MD.
e-mail:
[email protected]
Cosimo Nardi(1),MD,
PhD.
e-mail:
[email protected]
Massimo Saraceno Squadrelli(3),MD.
e-mail:
[email protected]
Massimo Trovati(3),MD.
e-mail:
[email protected]
Vittorino Miele(2),MD.
e-mail:
[email protected]
Stefano Colagrande(1),MD.
e-mail:
[email protected]
(1)Department of Experimental and Clinical Biomedical Sciences,
Radiodiagnostic Unit n.
2,
University of Florence - Azienda Ospedaliero-Universitaria Careggi.Largo Brambilla 3,
Florence,
Italy.Zip Code: 50134
(2)Department of Radiology,University of Florence - Azienda Ospedaliero-Universitaria Careggi.Viale Morgagni 85,
Florence,...
References
[1] Vallabhaneni D,
Mohamed A,
Badar Z et al (2016) Enhancing mass lesion of the sphenoid: atypical presentation of ongoing pneumatization.
Case Rep.
Pediatr.
[2] Aoki S,
Dillon WP,
Barkovich AJ,
Norman D (1989) Marrow conversion before pneumatization of the sphenoid sinus: assessment with MR imaging.
Radiology172: 373-5
[3] Szolar D,
Preidler K,
Ranner G et al (1994) Magnetic resonance assessment of age-related development of the sphenoid sinus.
Br.
J.
Radiol.
67: 431-5
[4] Kuntzler S,
Jankowski R.
(2014) Arrested pneumatization: witness of paranasal sinuses...