霉菌性和慢性化脓性鼻窦炎的CT鉴别诊断

The Role of CT in Differential Diagnosis of Mycotic Paranasal Sinusitis and Chronic Suppurative Paranasal Sinustis

目的:探讨CT在霉菌性和慢性化脓性鼻窦炎鉴别诊断。方法:对52例经手术后病理证实为霉菌性和慢性化脓性鼻窦炎患者的影像学、临床及手术病理资料进行回顾性分析。结果:霉菌性和慢性化脓性鼻窦炎CT表现的差异主要在以下3个方面:(1)病变范围:霉菌性鼻窦炎受累情况以单窦病变为主,66.7%的病例病变累及单侧上颌窦;慢性化脓性鼻窦炎多为双侧多鼻窦受累,79.4%病例病变累及双侧多个鼻窦。(2)病变密度:慢性化脓性鼻窦炎窦腔黏膜增厚、软组织团块影的密度均匀、无钙化灶;78.9%的霉菌性鼻窦炎的窦腔病变中有条带状、斑点状或团块状的高密度钙化影。(3)窦壁骨质的受累状况:化脓性鼻窦炎病例中未见窦腔骨质破坏;而霉菌性鼻窦炎病例中,44.4%的病例有不同程度的骨质吸收和破坏,位于上颌窦内侧壁。结论:CT扫描对霉菌性和慢性化脓性鼻窦炎的鉴别诊断有一定的价值。

Objective：To study the role of computer tomography（CT） in differential diagnosis of mycotic paranasal sinusitis and chronic suppurative paranasal sinustis. Methods：The CT characteristics of 18 cases of mycotic paranasal sinusitis and 34 cases of chronic suppurative paranasal sinustis diagnosed with pathologic examination were retrospectively analyzed. Results： There were three differente aspects of CT characteristics in mycotic paranasal sinusitis and chronic suppurative paranasal sinustis. （1）Extent of disease： mycotic paranasal sinusitis mainly destroyed single side of sinus, 66.7% cases infected unilateral maxillary sinus; the damage of chronic suppurative paranasal sinusitis mainly were bilateral maxillary sinus, 79.4% cases have polysinus were involved. （2） Density of the damage： sinus opacification frequently heterogeneous, fluid trapping, and with pseudotumoral appearance and highly calcification in 78.9% fungal paranasal sinusitis, while chronic suppurative paranasal sinusitis showed mucosal thickening and adqulis pseudotumoral appearance without calcification. （3） Bony changes： bone damage was seldom seen in chronic suppurative paranasal sinusitis. 44.4% cases of fungal paranasal sinusitis have bone changing in medial wall of maxillary sinus. Conclusion：CT scan has some role in diagnosing and differentitation of mycotic paranasal sinusitis from chronic suppurative paranasal sinustis.