Ostiomeatal Unit

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Fig. 6.4a,b. Frontal bone osteomyelitis secondary to acute right frontal sinusitis due to frontal recess blockage (arrows)

Concha Bullosa And Inflammation

Fig. 6.5a,b. Complicated acute rhinosinusitis. Axial CT after contrast administration. (a) Fluid material occupies both maxillary sinuses (a level is observed on the right) and a left concha bullosa (asterisks). The more cranial scan (b) shows an air-fluid collection within the anterior cranial fossa, bordered by thick and enhancing dura (arrows): epidural abscess. The absence of macroscopic defects of posterior frontal sinus wall suggests intracranial spread of infection through small veins perforating the diploe of frontal bone i \ 8

Fig. 6.5a,b. Complicated acute rhinosinusitis. Axial CT after contrast administration. (a) Fluid material occupies both maxillary sinuses (a level is observed on the right) and a left concha bullosa (asterisks). The more cranial scan (b) shows an air-fluid collection within the anterior cranial fossa, bordered by thick and enhancing dura (arrows): epidural abscess. The absence of macroscopic defects of posterior frontal sinus wall suggests intracranial spread of infection through small veins perforating the diploe of frontal bone b a b a

Subsequently, an overall increase in volume occurs as the result of an increase of central necrosis and peripheral edema. These components are undifferentiated at plain CT, whereas contrast administration demonstrates an irregular and enhancing rim separating them (Fig. 6.6). The abscess phase is characterized by the presence of a spontaneously hyperdense thin rim showing strong and homogeneous enhancement, and smooth inner surface. This peripheral ring may be pluriloculated or it may show small satellite rings, generally along its thinner medial border. Perilesional edema is a com mon finding, absent only in immunocompromised patients or in subjects under steroid therapy.

MR findings of cerebral abscesses are more sensitive. This technique actually better depicts subtle changes observed in the early cerebritic phase, such as sulcus effacement, mass effect, patchy enhancement along sulci and gray matter. Pus collections generally display the typical MR signal pattern of fluids (hyper T2, hypo T1, no enhancement), whereas the capsule bordering the abscess shows hypo T2 and hyper T1 signal with vivid contrast enhancement.

Ostiomeatal Unit Axial

Fig. 6.6a-d. Complicated acute rhinosinusitis. CT scan before (a-c) and after (d) contrast administration, on the axial plane. a,b Acute rhinosinusitis with ostiomeatal unit pattern: inflammatory material (asterisk) is detected in the middle meatus - between the middle turbinate (arrows) and the uncinate process (arrowhead) - and in the anterior ethmoid. c A more cranial scan also shows thickening of subcutaneous soft tissue in the frontal region (arrow). Focal discontinuities of cortical bone are detected on both inner and outer cortical surfaces of frontal bone (arrowheads). d After contrast injection, both epidural (EA) and in-traparenchymal abscess (arrow) are demonstrated

Fig. 6.6a-d. Complicated acute rhinosinusitis. CT scan before (a-c) and after (d) contrast administration, on the axial plane. a,b Acute rhinosinusitis with ostiomeatal unit pattern: inflammatory material (asterisk) is detected in the middle meatus - between the middle turbinate (arrows) and the uncinate process (arrowhead) - and in the anterior ethmoid. c A more cranial scan also shows thickening of subcutaneous soft tissue in the frontal region (arrow). Focal discontinuities of cortical bone are detected on both inner and outer cortical surfaces of frontal bone (arrowheads). d After contrast injection, both epidural (EA) and in-traparenchymal abscess (arrow) are demonstrated

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