Many score methods have been created to measure paranasal sinus abnormalities seen under CT scan. Currently, the Lund-Mackay staging system is widely accepted. However, its results may be affected by the development in children. Aim: To assess the precision and accuracy of a new tomography score, called "opacificationdevelopment ratio". It translates the percentage of sinus area that is opaque. Materials and Methods: A cross-sectional study was prospectively conducted in patients ranging from 0-18 years of age who underwent CT scan assessment of rhinosinusitis. Two independent radiologists examined each scan twice, using both the Lund system and the ratio herein proposed. Results: The opacification-development ratio reached substantial intra and inter-examiner agreement, similar to the Lund system (Kappa > 0.60). Considering the Lund system as the gold standard, the most accurate cutoff point was approximately 15 (sensitivity and specificity approach 90%). There was a strong linear correlation between the two methods (r > 90). Conclusions: opacification-development ratio is precise and correlates with the Lund system. A cutoff point set at 15 could be used to call a test positive.
Meningiomas are tumors of benign histological nature which represent 13 to 26% of all primary intracranial neoplasia 1 . Approximately 20% of intracranial meningiomas present extracranial dissemination at sites such as the orbit, middle ear, nasal cavity, nasopharynx and paranasal sinuses 2 . Primary extracranial meningiomas are histologically identical to intracranial meningiomas. They usually occur in 40 to 60-year-old patients and are rare in the pediatric age group. Primary extracranial meningiomas represent 1 to 2% of all meningiomas [1][2][3][4][5] . We to report the case of a 13-year-old girl with a primary extracranial meningioma of the ethmoid sinus, including the main findings of the imaging examination and a brief review of the literature. CaseA 13-year-old girl was referred to our service with a 30-day history of constant and strong frontal headache, nasal obstruction, and progressive proptosis of the left eye without signs of phlogiston or alterations in visual acuity.At rhinoscopy, a lesion of the soft tissues was observed occupying the left superior meatus of the nasal cavity with a smooth pink surface.In light of these findings, a CT of the skull and face sinuses was performed showing an extensive hypodense non-calcified lesion measuring 2.0x2.0 cm located in the left ethmoid sinus. The lesion presented heterogeneous iodinated contrast enhancement and demonstrated remodeling of the adjacent bone structures (Fig 1).MRI of the facial sinuses was requested to evaluate the involvement of the soft structures as well as the invasion of the adjacent structures and resection planes. The lesion in the left ethmoid sinus was hypointense in T1 and T2-weighted sequences, with heterogeneous paramagnetic contrast enhancement, determining a mass effect on the adjacent structures, lateral divergence of the medial rectus muscle of the left orbit, but with- out invasion (Fig 2). Additionally, maxillary and sphenoidal sinus disease was observed.The patient was submitted to excision of the lesion by external and endoscopic ethmoidectomy with a complete cure of the exophthalmus in the postoperative period. Diagnosis of atypical meningioma was attained by histopathological examination. disCussionThe present study shows the clinical and imaging aspects of primary extracranial meningioma of the ethmoid sinuses in a child. Primary extracranial meningioma of the nasal cavity or paranasal sinuses is rare, especially in children. The paranasal sinuses most commonly affected are the frontal, maxillary, ethmoid and sphenoid sinuses 2,3,5 .
Cerebral hemorrhages are fairly common in full-term neonates with no history of traumatic birth, mostly limited, and with benign evolution. We report a case of a full-term neonate from vaginal birth with caput succedaneum in the right parietal area. The neonate underwent cranial ultrasonography and color Doppler which showed extra-axial blood effusion. Color Doppler showed vessels crossing the collection area, which allowed the diagnosis of subarachnoid hematoma
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