Published ahead of print on April 10, 2008
doi: 10.3174/ajnr.A1042
Sinonasal Organized Hematoma: CT and MR Imaging Findings
E.Y. Kima,
H.-J. Kima,
S.-K. Chungb,
H.-J. Dhongb,
H.Y. Kimb,
Y.J. Yima,
S.T. Kima,
P. Jeona and
Y.-H. Koc
a Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
b Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
c Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Fig 1. Case 5. Organized hematoma of the maxillary sinus in a 50-year-old man. A, Precontrast axial CT scan with bone algorithm shows a large, expansile soft tissue mass in the right maxillary sinus with cortical thinning and scalloping of bony walls of the maxillary sinus. The ipsilateral nasal cavity is occluded by the lesion that pushes the medial maxillary sinus wall and nasal septum contralaterally (arrows). B, Axial T1-weighted MR image shows that the lesion is mostly isointense to the inferior turbinate interspersed with foci of hyperintensity. C, Axial, fat-suppressed, T2-weighted MR image shows the marked heterogeneity of the lesion with a mix of hypointense, isointense, and hyperintense signals. A dark peripheral rim surrounding the lesion is also well demonstrated. Note a bright signal intensity due to mucosal inflammation of the involved maxillary sinus (arrow), which is nicely distinguished from the lesion on T2-weighted images. D, Contrast-enhanced axial, fat-suppressed, T1-weighted MR image shows a marked frondlike, papillary enhancement within the lesion, roughly at the isointense areas on the T2-weighted image. E. Photomicrograph shows that the lesion consists mostly of extravasated red blood cells and prominent fibrosis (hematoxylin-eosin, original magnification, x400).
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Fig 2. Case 10. Organized hematoma of the maxillary sinus in a 76-year-old woman. A, Precontrast axial CT scan with bone window setting shows a large, expansile soft tissue mass in the right maxillary sinus, which causes cortical thinning and scalloping of bony walls of the maxillary sinus (arrows). With soft tissue windowing, the lesion is isoattenuated to the inferior turbinate with focal hyperattenuated area (data not shown). B, Contrast-enhanced axial CT scan shows marked irregular linear and nodular enhancement within the lesion. Note focal effacement of the retromaxillary fat by the expansile mass that causes smooth erosion of the sinus wall (arrow). C, Axial, fat-suppressed, T2-weighted MR image shows marked heterogeneity of the lesion composed of the areas of hypointensity and isointensity compared with the inferior turbinate. A dark peripheral rim surrounding the lesion is also well demonstrated.
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Fig 3. Case 2. Organized hematoma arising from antrochoanal polyp in a 12-year-old girl. A, Contrast-enhanced axial CT scan shows marked irregular nodular enhancement within a mass in the left maxillary sinus, which protrudes into the ipsilateral posterior nasal cavity through the widened maxillary sinus ostium. B, Axial, fat-suppressed, T2-weighted MR image reveals that the lesion is mixed hypointense and isointense to the inferior turbinate and is located inside the hyperintense antrochoanal polyp occupying the entire left maxillary sinus and posterior nasal cavity. Scattered foci of dark peripheral rim surrounding the lesion are also well demonstrated (arrows). Note the opacified ipsilateral mastoid air cells (*) caused by Eustachian tube obstruction by nasopharyngeal extension of the antrochoanal polyp. C, Contrast-enhanced axial, fat-suppressed, T1-weighted MR image shows the large areas of marked papillary enhancement within the lesion.
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