Problem of the Grottos

Sid Cavern (54) has been sent to the radiology department by his doctor to get some sinus radiographs done. The clinician has treated him for a sinusitis for a little while and is worried now because the clinical symptoms have not changed at all despite prolonged therapy. Paul and Hannah are covering the bone unit today. Having gathered a little experience with these patients, they know that two types of radiographs are needed for the proper evaluation of the paranasal sinus: the Waters view (Fig. 13.5a) to see the frontal, ethmoidal, and sphenoid sinuses well and the Caldwell view (Fig. 13.5b) for the important maxillary sinus. The two interns analyze the radiographs of Mr. Cavern (Fig. 13.6). Alternatively, the paranasal sinus can be evaluated with a limited coronal CT. No intravenous contrast administration is needed for this test and a few representative cuts provide a good overview and can exclude a significant inflammatory abnormality. However, in the case of Mr. Cavern, the plain films are well executed and nicely display the pathological finding.

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