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An imaging checklist for pre-FESS CT: framing a surgically relevant report
S. Vaid, N. Vaid, S. Rawat, A.T. Ahuja Clinical Radiology Volume 66, Issue 5, Pages (May 2011) DOI: /j.crad Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 1 Coronal CT image shows pneumatized vertical lamellae of the middle turbinates on both sides (arrows): interlamellar cells of Grunwald. Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 2 (a) Coronal CT image shows medially draining FSDP (arrowheads) into the middle meatus (MM) when the uncinate process (asterisk) attaches to the skull base/lamina papyracea (arrows). (b) A laterally draining FSDP (arrowheads) into the ethmoidal infundibulum (EE) when the uncinate process attaches to the middle turbinate (arrow). Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 3 (a) Coronal and (b) axial CT images show left maxillary sinus hypoplasia (asterisk) with laterally positioned and atelectatic uncinate process (arrows). Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 4 Coronal CT image depicting all six components of the OMC. MO, maxillary ostium; MM, middle meatus; EE, ethmoidal infundibulum; BE, bulla ethmoidalis; UP, uncinate process; HSL, hiatus semilunaris. Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 5 Coronal CT image shows normal right infraorbital foramen located along roof of right maxillary sinus (arrow). Left infraorbital foramen is dehiscent into the maxillary sinus (arrowhead). Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 6 Parasagittal CT image (a) shows superior extension of the frontal process of the maxilla forming the frontal beak (arrow). Coronal CT image in the same patient (b) shows the frontal beak (arrow) separating the frontal sinus (asterisk) above it from the frontal recess (curved arrow) below it. Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 7 (a) Parasagittal CT image shows a thin frontal beak (arrow) with resultant wide frontal ostium (asterisk). (b) A thick frontal beak with a narrow frontal ostium. Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 8 Parasagittal CT image showing typical “hour-glass” configuration of the FSDP (outlined by black and white arrows) draining inferiorly into the middle meatus. Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 9 (a–c) Sagittal CT images showing types 1–3 frontal cells (arrows). (d) Coronal CT image shows an isolated right type 4 frontal cell (arrow) surrounded by an opacified frontal sinus. Frontal beak (asterisk); agger nasi (an). Dotted line depicts the mid-point of the height of the ipsilateral frontal sinus. Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 10 Parasagittal CT image showing a large frontal bullar cell (asterisk), suprabullar in location (B, bulla ethmoidalis), with an anterior margin related to the frontal sinus (arrows) and posterior margin formed by the anterior skull base (arrowheads). Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 11 (a) Coronal CT image shows bilateral pneumatization of the basal lamellae (arrows). (b) Basal lamella on the right side (arrow) attaching to the lateral wall of the right maxillary sinus — the missed basal lamella. Arrowhead depicts normal basal lamella on the left side. Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 12 Coronal CT image. The white line (d) depicts the distance between the highest point of the superior margin of the maxillary sinus (white dotted line) and the roof of the posterior ethmoid sinus (arrows). Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 13 Coronal CT image shows horizontal and obliquely oriented sphenoid sinus septae (arrows) with Onodi cells (black arrowheads) into which the optic nerves are seen dehiscent (white arrowheads). An intersinus septum is seen attaching to the bone covering the right internal carotid artery (curved arrow). Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 14 Coronal CT images. (a) Bilateral endosinal vidian canals (arrows) and dehiscent right optic nerve with attachment of an intersinus septum (arrowhead). (b) Hyperpneumatized sphenoid sinus with an endosinal right foramen rotundum (arrow) and bilateral optic nerve dehiscence (arrowheads). Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 15 Coronal CT image showing a low-lying and medially sloping fovea ethmoidalis on right side (arrow) almost reaching the mid-orbital plane (horizontal white line). The dotted line depicts the vertical height of the right orbit. Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 16 (a) Coronal CT image shows normal bony canal for the anterior ethmoidal arteries on both sides (arrows). (b) The arteries suspended in a mesentry without any bone cover (arrows). Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 17 Coronal CT images depicting multiple focal areas of dehiscence in the lamina papyracea (LP) on both sides (arrows). Image section through the anterior orbit (a) shows adequate thickness of the orbital fat between the dehiscent LP and medial rectus muscle (arrowhead). Posteriorly (b) the thickness of this fat is markedly reduced (arrowhead). Focal areas of dehiscence in the cribriform plate are also seen on both sides (black arrows). Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 18 Coronal CT image. The dotted horizontal line represents the sagittal plane of the lamina papyracea, which should normally pass through the maxillary ostium (asterisk). A medially located lamina papyracea may predispose to inadvertent orbital penetration. Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 19 (a) Coronal CT image shows a focal osteolytic lesion involving the inferior wall of the left maxillary sinus with an associated soft-tissue mass (arrows). (b) HRCT image in bone windows reveals associated hyperostosis (asterisk). Histopathological examination confirmed the presence of granulation tissue due to tuberculosis. Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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Figure 20 Axial (a) and sagittal (b) CT images show an extensive remodelling deformity of the anterior skull base (arrows) due to chronic allergic fungal rhinosinusitis. Note the linear hyperdensities within the sinus, which is characteristic of chronic fungal disease (asterisk). Clinical Radiology , DOI: ( /j.crad ) Copyright © 2011 The Royal College of Radiologists Terms and Conditions
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