Sinonasal Computed Tomography in Patients With Wegener's Granulomatosis

Abstract

The goal of this study was to describe pathologies of sinonasal CT in patients with Wegener's granulomatosis. Between 1993 and 2004, sinonasal CT was performed in 28 patients (15 male, 13 female) with Wegener's granulomatosis. The following imaging findings were assessed on the CT scans: mucosal thickening, subtotal opacification, air-fluid level, bony destruction, sclerosing osteitis, bony thickening, orbital mass, and saddle nose deformity. Of the 28 patients, 61% showed mucosal thickening in the nasal cavity and 75% in the paranasal sinuses. A subtotal opacification of the paranasal sinuses was detected in 25%, and of the mastoid cells in 7% of patients. Fifty-seven percent of patients had bony destruction of the nasal cavity, and 54% of the paranasal sinuses. CT revealed sclerosing osteitis of the paranasal sinuses in 21%, and of the mastoid cells in 18% of patients. Bony thickening of the paranasal sinuses was detected in 18%, and of the mastoid cells in 14% of patients. With respect to all imaging findings, the maxillary sinuses were the most frequently affected paranasal sinuses. The authors conclude that the following sinonasal CT findings are observed in patients with Wegener's granulomatosis: (1) bony destruction, mainly of the nasal cavity, maxillary sinuses, and mastoid cells; (2) sclerosing osteitis, mainly of the maxillary sinuses and mastoid cells; (3) bony thickening, mainly of the maxillary sinuses and mastoid cells; and (4) mucosal thickening, mainly of the maxillary sinuses. These findings are, however, nonspecific and should be combined with other clinicopathologic and laboratory studies to confirm the diagnosis of Wegener's granulomatosis.

Wegener’s Granulomatosis Presenting With an Isolated Paranasal Sinus Involvement in a Child

“…Maxillary sinus involvement is mostly seen. 11,12 In our case, the CT findings were similar to those of Simmons et al 10 In the differential diagnosis of maxillofacial diseases, preseptal cellulitis, orbital cellulitis, sinusitis, osteomyelitis, malignancies should be considered along with vasculitis involving the upper respiratory tract. 5 Infectious causes such as cellulitis, acute sinusitis, and osteomyelitis can be easily differentiated by lack of fever in the disease course.…”

Imaging studies in the diagnosis and management of vasculitis

“…Sclerosing osteitis of the paranasal sinuses is seen 21% of patients and of the mastoid cells in 18%. Additionally, bony thickening is present in up to 18% of patients [45]. Even though no specific radiology criteria exist, CT may suggest the correct diagnosis at an early stage.…”

Imaging Features of Granulomatosis with Polyangiitis (Wegener’s)

“…Now, CT is a superior imaging technique to evaluate bone abnormalities (Benoudiba et al 2003;Lohrmann et al 2006). Therefore, a CT scan is performed without contrast agent, using a bone filter, with axial, coronal, and sagittal reformatting.…”

“…Subsequent bone deposition is due to a chronic periostitis caused by chronic granulomatous and vasculitic involvement of the sinus mucosa and the periosteum (Yang et al 2001;Benoudiba et al 2003;Lohrmann et al 2006). Other mechanisms have been suggested, such as chronic bacterial periostitis due to S. aureus or the complications of prior surgical manipulations.…”