CT检查在真菌性鼻窦炎术前诊断的意义

The value of CT scan in preoperative diagnosis of fungal sinusitis

目的 探讨CT检查在真菌性鼻窦炎术前诊断中的意义。方法 对67例真菌性鼻窦炎患者CT改变、临床表现和术中所见进行回顾性对比分析。结果 CT表现为:鼻窦充填密度不均软组织影29例,术前明确诊断为真菌性鼻窦炎12例;窦内充填软组织影伴散在不规则钙化灶34例,术前均明确诊断为真菌性鼻窦炎;上颌窦内壁吸收破坏21例,术前明确诊断为真菌性鼻窦炎14例;筛顶骨壁吸收破坏2例,术前均明确诊断为真菌性鼻窦炎;上颌窦骨壁出现增生硬化19例,术前明确诊断为真菌性鼻窦炎14例。67例中CT诊断鼻窦炎症60例,其中46例术前临床初诊为真菌性鼻窦炎,7例为上颌窦/筛窦肿物或占位性变。结论 窦腔内散在斑块状钙化的软组织充填是真菌性鼻窦炎CT诊断的主要征象,其它的CT表现常会导致术前误诊。虽然真菌性鼻窦炎的确诊有赖于病理学检查,但CT在其诊断中仍具有重要参考价值,并且是显示鼻窦解剖结构和病变范围的较好方法。

OBJECTIVE To discuss the value of CTin preoperative diagnosis of fungal sinusitis.METHODSThe CT scans,clinical manifestations and operativegross findings of 67 cases with fungal sinusitis wereretrospectively reviewed.RESULTS Fungal sinusitiswere preoperatively diagnosed in 12 of the 29 cases,which CT scan revealed a rim of soft tissue attenuationof variable thickening along the bony walls of the iso-lated paranasal sinus. Fungal sinusitis were totally pre-operatively diagnosed in 34 cases with calcified softtissue full of the sinuses in CT scans. The medial wallof maxillary sinus were absorbed and destroyed in 21cases,and 14 cases of them were diagnosed as fungalsinusitis preoperatively. The roof bony wall of ethmoidsinus were eroded in 2 cases and fungal sinusitis werediagnosed preoperatively. The wall except medial wallof maxillary sinus were stiffen in 19 cases and 14 casesof them were diagnosed as fungal sinusitispreoperatively. 46 of 60 cases were preoperatively di-agnosed as fungal sinusitis with the CT scans showedsinusitis findings. The CT scans showed occupyingmass in maxillary and/or ethmoid sinuses in 7 of allthe 67 cases.CONCLUSION It is the characteristicsof CT preoperatively diagnosed the fungal sinusitis thatreveal the calcified soft tissue full of the sinuses. Theother CT findings may induce clinical misdiagnosis.When patients are clinically diagnosed as fungussinusitis, pathologic examination must be carried out.CT scan can give important reference and show adja-cent anatomic structure of the sinuses and the exten-sion of the diseases.[