Sir, I have been doing my ENT radiology rotations and your classes were of great help. My only question when i came across multiple cases is to differentiate between sinonasal polyposis and inverted papilloma, most of the times, the clinicians here request to give diagnosis based on ct alone
Sometimes, you cannot be completely certain. But sometimes there are imaging clues. IP should erode the medial wall of the maxillary sinus to involve both the nasal cavity and the sinus, whereas antronasal polyps remodel the wall and extend through the ostiomeatal complex. IP can have a characteristic pattern of calcification, but polyps don't calcify. On MRI, an IP may have cerebriform enhancement, whereas polyps will have a mucosal line of enhancement peripherally but otherwise be uniform. When an IP occurs in an unusual location or has unusual enhancement, you may not be able to tell the difference.
@@ENT_Imaging Thanks a lot for answering my query. And please continue making videos at your convenience as we have been watching all your videos very religiously
Thanks for this comprehensive review of all the important lesions in this region. I have a query- we see bone remodelling in mucocele into a spherical like shape , but is bony erosion a common feature of mucocele? And if bony erosion is present, how can we differentiate it from other aggressive lesions. Please comment on this.
Great question. I believe that it is critical to distinguish between "erosion" and "remodeling". Radiologists are often sloppy about this distinction, and it creates confusion. The problem comes when a mucocele remodels bone so much that the bone becomes too thin to be appreciated on CT. Some radiologists label this "erosion" because they cannot see the bone. But this is misleading; the word "erosion" should be reserved for aggressive processes. [Note: As part of remodeling, mucoceles can cause microscopic erosion of bone, but they do not cause macroscopic erosion that is visible on CT.]
A mucocele is an enlarged air cell (like, the whole maxillary sinus), so it has bone remodeling. I suspect that you meant mucus retention cyst vs. polyp. Most of the time, you can't tell them apart (sometimes, you get lucky with a thin attachment point for a polyp, while MRCs are usually broad-based). But thankfully, it doesn't matter! Both polyps and MRCs reflect chronic inflammation, so if I mistake one for the other, it doesn't really affect patient care. I usually call them polyps in the nasal cavity and MRCs in the sinuses, and if I get it wrong, I don't care.
Not sure what you mean by "clinical implications". The role of the radiologist is mostly to establish extent of disease, especially perineural spread or soft tissue extent outside the sinuses. Making a specific diagnosis is less important -- it's going to be biopsied no matter what you say it is. If it is a very vascular tumor, it is nice to warn the surgeon that they are in for some bleeding.
I reviewed your series 2 3 times to reinforce my understanding.
excellent.
Sir, I have been doing my ENT radiology rotations and your classes were of great help. My only question when i came across multiple cases is to differentiate between sinonasal polyposis and inverted papilloma, most of the times, the clinicians here request to give diagnosis based on ct alone
Sometimes, you cannot be completely certain. But sometimes there are imaging clues. IP should erode the medial wall of the maxillary sinus to involve both the nasal cavity and the sinus, whereas antronasal polyps remodel the wall and extend through the ostiomeatal complex. IP can have a characteristic pattern of calcification, but polyps don't calcify. On MRI, an IP may have cerebriform enhancement, whereas polyps will have a mucosal line of enhancement peripherally but otherwise be uniform. When an IP occurs in an unusual location or has unusual enhancement, you may not be able to tell the difference.
I'm happy to hear that the videos have been useful to you. I never expected them to so this much attention outside of my own institution.
@@ENT_Imaging Thanks a lot for answering my query. And please continue making videos at your convenience as we have been watching all your videos very religiously
Thanks for this comprehensive review of all the important lesions in this region. I have a query- we see bone remodelling in mucocele into a spherical like shape , but is bony erosion a common feature of mucocele? And if bony erosion is present, how can we differentiate it from other aggressive lesions. Please comment on this.
Great question. I believe that it is critical to distinguish between "erosion" and "remodeling". Radiologists are often sloppy about this distinction, and it creates confusion.
The problem comes when a mucocele remodels bone so much that the bone becomes too thin to be appreciated on CT. Some radiologists label this "erosion" because they cannot see the bone. But this is misleading; the word "erosion" should be reserved for aggressive processes.
[Note: As part of remodeling, mucoceles can cause microscopic erosion of bone, but they do not cause macroscopic erosion that is visible on CT.]
@@ENT_Imaging Thanks for explaining.
sir barton how we differentiate enteronasal polyp from mucocele?
A mucocele is an enlarged air cell (like, the whole maxillary sinus), so it has bone remodeling. I suspect that you meant mucus retention cyst vs. polyp. Most of the time, you can't tell them apart (sometimes, you get lucky with a thin attachment point for a polyp, while MRCs are usually broad-based). But thankfully, it doesn't matter! Both polyps and MRCs reflect chronic inflammation, so if I mistake one for the other, it doesn't really affect patient care. I usually call them polyps in the nasal cavity and MRCs in the sinuses, and if I get it wrong, I don't care.
what are the clinical implications of paranasal sinus malignances
Not sure what you mean by "clinical implications". The role of the radiologist is mostly to establish extent of disease, especially perineural spread or soft tissue extent outside the sinuses. Making a specific diagnosis is less important -- it's going to be biopsied no matter what you say it is. If it is a very vascular tumor, it is nice to warn the surgeon that they are in for some bleeding.