The clinical and radiologic records of 500 sequential patients who underwent screening sinus CT as a prelude to possible functional endoscopic sinus surgery (FESS) were reviewed in order to answer three clinical-radiologic questions: (1) Can distinct radiologic patterns of inflammatory disease be identified on screening sinus CT (SSCT)? (2) If so, what are these radiologic patterns? (3) How do the findings seen on SSCT influence the endoscopic surgical plan? Five basic radiologic patterns of sinonasal inflammatory disease were identified among the 500-member patient population. These were based on known patterns of mucociliary drainage correlated with obstructive patterns observed on the CT scans. These radiologic patterns included: (1) infundibular (129 of 500 or 26%), (2) ostiomeatal unit (126 of 500 or 25%), (3) sphenoethmoidal recess (32 of 500 or 6%), (4) sinonasal polyposis (49 of 500 or 10%), and (5) sporadia (unclassifiable) (121 of 500 or 24%) patterns. Normal SSCT was seen in 133 of the 500 patients (27%). Although the ostiomeatal unit is the central feature in sinonasal inflammatory disease, obstruction of the infundibulum alone or of the sphenoethmoidal recess can cause unique inflammatory patterns of disease that require tailored FESS. The identification of sinonasal polyposis raises a different set of FESS considerations. The sporadic pattern of inflammatory disease, when identified, creates unique FESS challenges, depending on the specific sinus or sinuses involved. Assignment of these patterns to the individual case also assists in patient management by grouping patients into nonsurgical (normal CT), routine (infundibular, ostiomeatal unit, and most sporadic patterns) and complex (sinonasal polyposis and sphenoethmoidal recess) surgical groups.

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Hemangiopericytomas are rare tumors of the head and neck. The benign presentation of this tumor belies its high local recurrence rate, local aggressiveness, and malignant potential. In view of these characteristics, workup to provide a diagnosis preoperatively is of significant importance. Diagnostic imaging is helpful in planning operative management, detecting metastases, and narrowing the list of differential diagnoses. However, because of the variety and lack of specificity of radiologic findings, it is generally difficult to provide a diagnosis. A history of a painless, slowly growing, otherwise asymptomatic mass, together with the radiologic findings of a vascular neoplasm, should enhance the suspicion of an HPC as a diagnosis. Hemangiopericytoma should be included in the differential diagnosis of any vascular soft tissue lesion presenting in the head and neck, and plans for surgical intervention should include the possibility of aggressive, wide local resection in order to adequately treat such a lesion should it be encountered.