CASE 13564 Published on 09.05.2016

A rare case of sinolith in the ethmoid sinus

Section

Head & neck imaging

Case Type

Clinical Cases

Authors

Funda Dinç Elibol, Cenk Elibol, Süha Gül

Department of Radiology,
Muğla Sıtkı Koçman University Education and Research Hospital,
Muğla, Turkey
Email:fundadi@yahoo.com
Patient

43 years, female

Categories
Area of Interest Head and neck ; Imaging Technique CT, MR
Clinical History
A 43-year-old woman complained of nasal obstruction and sinusitis symptoms. Based on the CT and MRI findings, a diagnosis of ethmoid sinolith was made.
Imaging Findings
Unenhanced axial and coronal CT scans revealed a calcified, hyperdense irregular-shaped mass in the left ethmoid region bulging into the sphenoid sinus. Mucosal thickening in the right maxillary sinus and inflammatory tissue in the ethmoidal air cells was also noted. MRI showed a signal void mass in the ethmoid sinus on both T1 weighted and T2 weighted axial images. Also inflammatory tissue in ethmoidal sinuses was demonstrated.
Discussion
Rhinolithiasis was first described by Polson in 1943 as calcified bodies in the nasal cavity [1]. Later, in 1969, the term maxillary antrolith was used by Bowerman to differentiate these from rhinolithiasis [2]. These calcified bodies have been variously described as antral rhinoliths, antral stones, antral calculi, antroliths, sinoliths, and antrorhinoliths. Sinolithiasis is usually found in maxillary sinuses [3]. In the literature, a limited number of frontal, sphenoid, and ethmoid sinoliths have been reported [4-11].
The pathoaetiology of sinoliths is still not clearly known. Chronic and fungal infections, foreign material, poor sinus drainage and aeration are predisposing factors [2, 3, 10, 11]. Nasal obstruction and discharge are the most common symptoms of ethmoid sinoliths [9, 10]. Occasionally sinoliths are asymptomatic and detected incidentally [8, 11].
CT is useful in detecting and localizing a sinolith precisely. CT shows characteristic features of a stone, its relation to adjacent tissues as well as coexisting inflammatory changes. Sinoliths may show homogenous or heterogenous density on CT [2, 3, 9, 10, 12]. CT displays bony detail and anatomic landmarks; however, MRI is better at revealing complications of sinus inflammatory disease [13]. Treatment of an ethmoid sinolith includes endoscopic sinus surgery with appropriate treatment of associated sinus pathology [9, 10].
A sinolith in the ethmoid sinuses is still a rare entity and the diagnosis is most easily made on CT [9, 10]. It should be considered in the differential diagnosis of high density sinus lesions in patients with nasal obstruction and sinusitis that does not respond to medical therapy [3].
Differential Diagnosis List
Ethmoidal sinolith, ethmoid sinusitis
Osteoma
Calcified mucus retention cyst
Ossifying fibroma
Final Diagnosis
Ethmoidal sinolith, ethmoid sinusitis
Case information
URL: https://www.eurorad.org/case/13564
DOI: 10.1594/EURORAD/CASE.13564
ISSN: 1563-4086
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