上颌窦后鼻孔息肉(Antrochoanal polyp)CT病例图片影像诊断分析

鼻窦   2010-10-24

 【临床病史】:患者,16岁女性,出现慢性副鼻窦炎。16-year-old female with chronic sinusitis.

【影像图片】CT图像

上颌窦后鼻孔息肉上颌窦后鼻孔息肉

上颌窦后鼻孔息肉上颌窦后鼻孔息肉

【影像表现】:Figure 1: Noncontrast axial CT image in bone window demonstrating a low density mass opacifying the left maxillary sinus extending to the posterior choana. No bony destruction is present (yellow arrows).平扫轴位CT骨窗图像显示左侧上颌窦腔内低密度肿块充填,并扩展至后鼻孔,无骨质破坏(黄箭)

    Figure 2: Noncontrast coronal CT image in soft tissue window better demonstrating the lesion extending through the middle meatus (yellow arrow). Contralateral maxillary antral mucosal thickening is present.冠状位CT软组织窗更好的显示了病变通过中鼻道的延伸(黄箭)。对侧上颌窦粘膜肥厚。

【影像诊断】:Antralchoanal polyp 上颌窦后鼻孔息肉

【诊断要点】:Antralchoanal polyps present as mucoid masses originating at the maxillary antrum extending through a sinus ostium to the choana. 上颌窦后鼻孔息肉表现为起源于上颌窦的粘液样肿块,并通过上颌窦口延伸至后鼻孔。

    Antralchoanal polyps demonstrate non aggressive features with only peripheral enhancement. 上颌窦后鼻孔息肉表现为非侵袭性肿块,仅有周边强化。

    Treatment is complete surgical resection.治疗通常通过外科手术。

【讨论】:Originally described by Killian in 1906, antrochoanal polyps result from edematous hyperplasia of respiratory epithelium that herniates through the maxillary infundibulum or the ostium of the maxillary sinus to the level of the posterior choanal (boundary of the nasal cavity and nasopharynx). They commonly arise from the maxillary antrum, hence antrochoanal; however nasochoanal, sphenochoanal, and ethmochoanal polyps have been reported. They comprise 4-6% of all sinonasal polyps and are frequently associated with bilateral maxillary sinusitis. Younger males with a mean age approximately 10 years, presenting with unilateral nasal obstruction is the typical clinical scenario.

    上颌窦后鼻孔息肉是由Killian在1906年首次描述,它是起因于呼吸上皮水肿增生并通过颚骨漏斗或上颌窦孔疝入至后鼻孔水平(鼻腔和鼻咽交界处)。病变通常起于上颌窦腔,疝入至后鼻孔;然而鼻后孔、蝶后孔以及筛后孔息肉也都有报道。占所有的鼻窦息肉的4-6%并且常常伴有双侧上颌窦炎。年轻男性,平均年龄大约是10岁,出现单侧鼻塞是典型的临床表现。

    Non-contrast CT imaging will usually reveal a large dumbbell shaped, up to 5-6 cm, mucoid density mass occupying the maxillary sinus, exiting via a widened ostium, and into the nasopharyngeal airway. Rarely will antrochoanal polyps extend deep into the nasopharynx or protrude through a nostril. Peripheral enhancement is frequently seen without central enhancement. MR imaging reveals similar findings with hypointense to variable T1 signal. The lesion is hyperintense on T2WI with only peripheral enhancement.

    平扫CT通常表现为一个大的哑铃状,大至5-6cm的粘液样肿块,占据整个上颌窦腔,通过增宽的上颌窦口向外延伸,并且进入鼻咽呼吸道。很少的情况下后鼻孔息肉也可以深入至鼻咽腔或突入鼻孔。增强扫描常常表现为外周强化,中央无强化。MR影像显示类似改变,T1序列多为低信号,也可以是其他信号,T2序列通常表现为高信号,仅有外周强化。

    Differential diagnosis includes intranasal glioma, nasoethmoidal encephalocele, juvenile angiofibroma, inverted papilloma, and esthesioneuroblastoma. Intranasal gliomas usually present at birth or the very young as a soft tissue mass centered at the nasal dorsum. Nasoethmoidal encephaloceles present at birth with a frontal, nasal or medial orbital soft tissue mass contiguous with intracranial brain parenchyma extending through a bony defect. Juvenile angiofibromas present in adolescent males as an intensely enhancing mass originating at the sphenopalatine foramen extending into the posterior nasopharynx. Inverted papillomas are usually found in older males as a locally aggressive mass centered at the middle meatus extending into the maxillary sinus and nasal cavity. Esthesioneuroblastomas present in the second and sixth decades as a solid enhancing mass centered within the superior nasal cavity extending into the cribriform plate. Complete surgical resection is the treatment of choice with mean time to recurrence of 45 months.

    鉴别诊断包括鼻腔内胶质瘤、鼻筛部脑膨出、青少年血管纤维瘤、内翻性乳头状瘤和成感觉细胞瘤。鼻腔内胶质瘤通常见于刚出生或非常年幼的患者,肿块中心位于鼻背部。鼻筛部脑膨出表现为一个额窦、鼻腔或眶内侧软组织肿块,邻近的颅内脑实质通过骨质缺损处疝出。青少年性血管纤维瘤见于青少年男性,有明显强化,起源于蝶腭孔并扩张至鼻咽部。内翻乳头状瘤通常见于年龄更大的男性,有局部的侵蚀性,病变中心位于中鼻道并扩展至上颌窦和鼻腔。成感觉细胞瘤见于20和60岁的人群,表现为实性的强化肿块,病变中心位于上鼻腔并扩展至筛板。外科切除是治疗的首选,复发的平均时间是45个月。

(参考来源:,ACR Monday, November 2, 2009,作者:freemanpyw )
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