CT imaging of sinonasal disease in cystic fibrosis Impiego della TC nella valutazione della patologia rinosinusale in pazienti con fibrosi cistica

Cystic fibrosis is a common predisposing factor for sinusitis and sinonasal polyposis. However, unlike the imaging of lung alterations, examination of the paranasal sinuses is often confined to x-ray and seldom extends to CT. After EN T examination and endoscopy, 18 young patients with cystic fibrosis underwent low dose coronal CT scan of the paranasal sinuses. All 18 patients showed CT enhancement of the maxillary sinuses with mucosal thickening and inspissated secretions. Five asymptomatic patients with a negative ENT examinations showed a normal middle meatus while the remaining 13, positive at ENT examination with symptoms suggesting sinonasal inflammation, showed obstruction of the infundibulum (bilateral in ten, monolateral in three). The scans also showed enhancing anterior ethmoid (9), posterior ethmoid (4), frontal sinus (7), sphenoidal sinus (4), polypoid- like pathological tissue in the middle meatus (4) and massive polyposis (1). CT also demonstrated sclerosis and bone thickening of the sinus walls, retention cysts or mucoceles. Functional endoscopic surgery is the treatment of choice for polyposis and chronic or recurrent inflammation that fails to respond to therapy. After preliminary endoscopy in symptomatic patients, CT will demonstrate any obstruction, the extent of disease and offer a detailed evaluation of the sinonasal cavities and surrounding structures, thus reducing operative risk.