Parietal opacities of the maxillary sinuses

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Parietal thickening of the mucous membrane of the maxillary sinus, what is it?

Many patients who came to see an ENT doctor, after the examination, hear that they have been diagnosed with thickening of the mucous membrane of the maxillary sinus.

Table of contents:

This situation is very common and requires increased attention, because it can indicate a serious pathology. Why this happens, what the symptom indicates, and how disorders in the maxillary sinus can be eliminated - it is not possible to deal with these questions on your own.

General information

All paranasal sinuses are covered with mucous membrane. It is a columnar epithelium with cilia, goblet cells and mucous glands, which is fairly well supplied with blood. The main function of this layer is to cleanse the sinuses and warm the air in them. The mucous membrane of the maxillary sinus can be determined by the results of an x-ray examination. And if previously a thickness of less than 5 mm was considered the norm, now they say that the healthy epithelial lining is not visible at all - only the smooth contour of the bone walls.

Causes and mechanisms

If the mucous membrane thickens, it means pathological processes are occurring in it. They are manifested by edema, increased vascular permeability, infiltration and increased division of cellular elements. Therefore, the mechanism of violations can be different:

  • Inflammation (sinusitis).
  • Tissue hypertrophy.
  • Allergic reaction.
  • Neurovegetative disorders.

The infection enters the sinuses from the nasal cavity, and its further development is facilitated by a violation of the outflow of physiological secretions. The mucus stagnates and becomes a favorable environment for the proliferation of microbes. But parietal swelling of the mucous membrane can occur not only with sinusitis, but as a result of acute respiratory viral infection or another cold, persisting even during the recovery period. And additional factors are:

  • Smoking.
  • Dry and polluted air.
  • Injuries and nasal polyps.
  • Deviation of the nasal septum.

Allergic reactions, like inflammation, are accompanied by swelling. But it has a different origin. An increase in vascular permeability is initiated by allergy mediators (histamine, serotonin). The latter are secreted by mast cells in response to the binding of the allergen to immunoglobulins E absorbed on their surface.

A reaction with swelling of the mucous membrane can also occur with neurovegetative disorders. A decrease in vascular tone leads to expansion of the corpora cavernosa and thickening of the walls of the sinuses. This is facilitated by hormonal disorders and long-term use of nasal decongestants. And hyperplasia of the mucous membrane of the maxillary sinuses is a sign of a chronic process when long-term cellular infiltration develops into tissue disorders akin to tumors.

The mucous membrane of the maxillary sinuses can thicken for various reasons. But to establish the source of the pathology, diagnosis is necessary.

Symptoms

The clinical picture of the condition in question is variable. With slight thickening, there may be no symptoms. But even swelling of about 3 mm in the area of ​​the sinus openings can lead to a deterioration in aeration and outflow of secretions. And with more pronounced changes, the symptoms will become obvious:

  • Difficulty in nasal breathing.
  • Nasal discharge.
  • Sneezing.
  • Decreased sense of smell.
  • Feeling of pressure in the sinus area.

Acute sinusitis in case of untimely diagnosis transforms into a chronic inflammatory process (including hypertrophic). In addition to the above symptoms, it is characterized by a feeling of heaviness in the projection of the maxillary sinuses and periodic headaches. Due to impaired nasal breathing, the mucous membrane of the oropharynx dries out, sometimes the ears become blocked, sleep is disturbed and work capacity is reduced. And during periods of exacerbation, the temperature rises, malaise and weakness occur.

Atopic rhinitis is accompanied by profuse rhinorrhea, paroxysmal sneezing, itching in the nose and lacrimation. Such patients are likely to develop concomitant diseases (conjunctivitis, dermatitis, bronchial asthma). Neurovegetative runny nose has similar symptoms, but it is not associated with allergens. If the examination was carried out during the recovery period from ARVI, then among the probable signs there may be only minor nasal discharge and coughing.

Additional diagnostics

The thickening of the mucous membrane of the maxillary sinuses itself is determined using conventional radiography or computed tomography. But these studies are not enough to establish the reasons. Patients are prescribed additional diagnostic procedures:

  • General blood analysis.
  • Analysis of nasal discharge.
  • Allergy tests.
  • Rhinoscopy.
  • Sinus endoscopy.
  • Biopsy with histology.
  • Puncture of the paranasal sinuses.

Based on the results obtained, it is possible to form a complete picture of what is happening. And having made a diagnosis, you can proceed to the next stage of medical care - treatment.

X-ray methods alone do not allow us to determine the cause of mucosal thickening. To do this, it is necessary to expand the list of diagnostic measures.

Treatment

Consolidation of the sinus mucosa is, in fact, one of the morphological manifestations of the pathological process. And its cause should be treated. For sinusitis, medications come first:

  • Vasoconstrictors (Otrivin, Nazivin, Noxprey).
  • Antiseptics (Chlorophyllipt, Dimexide, furacillin).
  • Antibiotics (Augmentin, Xefocam, Sumamed).

The drugs are prescribed in forms for local (drops and sprays, rinsing solutions) and systemic use (tablets, injections). But any medications should be taken only on the recommendation of a doctor to avoid negative consequences, including drug-induced rhinitis. For atopic rhinitis, antihistamines (Allergodil, Tavegil) and topical corticosteroids (Flixonase, Nasonex) are required. In this same situation, it is extremely important to completely eliminate contact with the causative allergens.

Inflammation in the maxillary sinuses can be treated by washing with a YAMIK catheter and physiotherapy (UHF, EF, laser therapy). If the effect of conservative measures is not enough, then a puncture is performed for sinusitis, evacuating pus from the affected sinuses and washing them. And the hypertrophic process requires surgical manipulation - endoscopic or radical sanitation (according to Caldwell-Luc).

When the results of the initial examination reveal that the mucous membrane of the sinuses is thickened, it is necessary to first understand the cause of the changes. This process can be observed in inflammatory and hypertrophic disorders, allergic and neurovegetative disorders. And only after the patient undergoes additional diagnostics will it become clear what he is dealing with and how to cure the disease.

Source: http://elaxsir.ru/simptomy/drugie/utolshhenie-slizistoj-gajmorovoj-pazuxi.html

Symptoms and treatment of parietal sinusitis

Sinusitis is characterized by the development of an inflammatory process in the paranasal sinuses. Parietal sinusitis is a chronic form of the disease, but is not accompanied by the development of purulent processes. It develops when the acute form of inflammation has not been adequately treated and is accompanied by constant swelling of the wall of the sinus. In this case, swelling can be observed on one or both sides.

Reasons for the development of parietal sinusitis

Sinusitis is a consequence of an infection entering the body. The parietal form develops when bacteria remain in the nasal sinuses for a long time, which include:

In addition to bacteria, the development of inflammation can result from:

  • Inadequate treatment for colds;
  • Inadequate therapy for allergic rhinitis;
  • Measles and scarlet fever;
  • Inflammation in the oral cavity, in particular – the roots of the teeth, localized near the nasal sinuses;
  • Tonsillitis and pharyngitis;
  • Deviation of the nasal septum.

It should be borne in mind that the presence of any of these causes is not necessary for the development of the disease. It can occur due to weakened immunity - this reason is most relevant in the off-season.

Symptoms

Characteristic symptoms of the parietal form of the disease are:

  • Difficulty in clearing mucus from the nasal cavity;
  • Secretion with blood streaks;
  • Headache localized in the frontal region;
  • Pain localized in the area of ​​the nose, bridge of the nose;
  • Temperature rise;
  • Inability to breathe through the nose;
  • Pain in the eyes.

The course of the disease is accompanied by a decrease in vitality and fatigue. The chronic form of the disease can lead to conjunctivitis, chronic migraines, and constant cough. In advanced cases, the infection can spread to the brain area and cause meningitis.

The basis of the symptoms is pain. They can be different, but they always indicate the development of an inflammatory process in the maxillary sinuses. Most often, the pain is localized on the side where the inflammation occurs. In this case, the classic sign will be irradiation to the temporal region, half of the face or head.

If these symptoms are accompanied by pain when changing the position of the head, this will indicate the progression of inflammation and damage to the frontal sinuses by the inflammatory process.

The nature of inflammation can be determined by the secretion released. With serous inflammation, the discharge is clear and liquid. Thick discharge with a greenish tint and an unpleasant odor indicates an inflammatory reaction with the formation of pus.

Diagnostic measures

The diagnosis is made by an otolaryngologist after rhinoscopy. During the diagnostic procedure, hyperemia (redness) of the nasal mucosa, swelling, and changes in the thickness of blood vessels (thinning) are detected. If symptoms indicating a chronic form of the disease are detected, an x-ray of the sinuses is prescribed. A more accurate diagnostic method is multislice spiral tomography.

Treatment

Therapeutic measures are aimed primarily at eliminating swelling. If the disease occurs without complications, it is easily treatable. In such cases, there is no need for intervention - puncture or sinusotomy. But even in relatively mild situations, treatment should be selected by a specialist, since it often includes antibiotic therapy, which should be prescribed after the pathogen is identified.

The main methods of treatment include:

  • Using saline solutions to rinse the nasal cavity. Washing is carried out using a syringe, syringe, or using ready-made solutions of sea water with nozzles (Humer, Aqualor).
  • The duration of taking antihistamines intended to reduce swelling is determined by the doctor, and it can range from 1 to 2 weeks.
  • If pain is present, anti-inflammatory drugs (Ibuprofen) are prescribed.
  • Irrigation of the nasal cavity with sprays that have a vasoconstrictor effect.
  • The use of special antibacterial drugs intended for irrigation of the nasal cavity (Polydex). Sometimes washing is carried out with solutions based on conventional antibiotics (Amoxiclav).
  • In cases of significant parietal swelling, the use of nasal corticosteroids (Nasonex) is prescribed.

Experts recommend combining drug therapy with physiotherapy. In this case, laser therapy and UHF may be prescribed.

Traditional medicine recipes also contain methods to cope with parietal sinusitis. However, we should not forget that any traditional methods can be used only after consultation with a specialist and act as an additional, rather than primary treatment. Some of the ingredients recommended in traditional medicine can cause an allergic reaction.

  • Instill 3 drops of aloe juice into each nasal passage for a week.
  • Mix carrot juice with vegetable oil (in a 1:1 ratio). The mixture is used for instillation 2 times a day for 1.5 weeks.

Restrictions

Since this is a bacterial disease, precautions must be taken to prevent further spread of bacteria. To do this, you should blow your nose and wash it in such a way as to prevent infection from entering the auditory tube.

It is not recommended to do warm-ups on your own, without consulting a doctor. In some cases, this can lead to increased swelling.

Preventive actions

Sinusitis is a disease that people with good immunity need not be afraid of. Therefore, in this case, classic recommendations for strengthening the immune system are relevant. These include proper and nutritious nutrition, and in the off-season - additional intake of vitamins. It is also important to maintain a work-rest schedule, since a tired, exhausted body “succumbs” to infections much faster.

Hypothermia and contact with bacteria carriers should be avoided. It should also be noted that rinsing with salt water refers not only to methods of treatment, but also to methods of prevention, therefore, after visiting places with large crowds of people during the season of increased incidence, it is recommended to rinse the nose with saline solutions.

Source: http://noslor.ru/gajmorit/pristenochnyj.html

X-ray of the paranasal sinuses (PSN): how and why they are done, pictures, example of a description (transcript)

X-ray of the paranasal sinuses (X-ray of the paranasal sinuses) shows pneumatization of these anatomical structures. An X-ray image shows fluid accumulations, tumors, foreign objects, and cysts.

What does x-ray of the paranasal sinuses show - x-ray anatomy of the face

X-ray shows the following paranasal sinuses:

X-ray of PPN with bilateral sinusitis. X-ray anatomy of the formations was noted

What do the normal sinuses look like on an x-ray?

Normally, the paranasal sinuses on an x-ray look like this:

  1. The bone walls have clear contours.
  2. The pneumatization (airiness) of the PPN is compared with the orbits (standard).
  3. The contours of the lattice cells can be traced.

An X-ray of the sinuses (paranasal sinuses) is prescribed to determine sinusitis (inflammation) in the initial stages. Deciphering it is not particularly difficult for a radiologist.

What diseases are visible on X-ray of PPN?

X-ray of the PPN shows sinusitis, which according to localization is classified into:

  • sinusitis - maxillary inflammation;
  • frontal sinusitis - in the frontal part;
  • ethmoiditis - darkening of the mastoid cells;
  • sphenoiditis – sphenoid bone.
The term “sinusitis” comes from the Latin “sinus”, which means “sinus” and –itis- “inflammation”. Pathology is an inflammatory process in one or more nasal sinuses, occurring as a consequence of influenza, scarlet fever, measles, rhinitis and other infections.

Interpretation of the radiograph of the PPN

The presented radiograph of the paranasal sinuses visualizes a decrease in pneumatization of the left maxillary sinus in the lower third with the upper horizontal level. Conclusion: X-ray signs of left-sided maxillary sinusitis (sinusitis).

In the picture above you can see the parietal darkening of both maxillary sinuses. Its description will lead to the logical conclusion of bilateral sinusitis.

X-ray of the paranasal sinuses allows not only to diagnose pathology, but also to analyze the dynamics of treatment. When sinusitis is detected in a patient, doctors prescribe several images: the first – immediately after the inflammation is detected; the second and subsequent ones - during treatment with antibiotics.

Deciphering a radiograph of the PPN requires analysis of other anatomical structures that can be traced in the image - bones, oral cavity, eye orbits. Tumors can sometimes be found in them, which are an incidental but important finding.

Deciphering one radiograph takes about 10 minutes of a radiologist's time.

Schematic representation of PPN diseases

Why do doctors prescribe x-rays of the paranasal sinuses?

Doctors order x-rays of the paranasal sinuses to detect sinusitis. Readers understood this from the above part of the article. As radiologists say, sinusitis and sinusitis are different, so here is a classification of pathology according to form:

  1. Exudative.
  2. Catarrhal, serous, purulent.
  3. Parietal-hyperplastic.
  4. Productive.
  5. Polypous.

Each of these forms is clearly visualized by radiography of the PPN. Only if the X-ray symptoms of the disease are unclear can the study be supplemented with CT (computed tomography).

Exudative sinusitis (frontal sinusitis, sinusitis) is visualized as a darkening with an upper horizontal border.

The parietal-hyperplastic form can be traced as parietal darkening due to thickening of the mucous membrane near the bone walls. The contour of the sinuses (paranasal sinuses) with this sinusitis is turned inward and is slightly uneven or wavy.

Polypous sinusitis is manifested by a parietal protrusion on a pedicle, facing inward.

The X-ray picture of catarrhal, serous or purulent sinusitis resembles exudative one. The only difference is the morphological substrate of the liquid that is obtained after puncture (piercing).

Depending on the location, the following forms of sinusitis are distinguished:

  1. Hemisinusitis is a lesion of the PPN on both sides.
  2. Pansinusitis is inflammatory changes in all paranasal cavities.

What is a cyst and how does a picture of the paranasal sinuses show it?

A cyst on an X-ray of PPN is an unexpected finding for the physician. It has no special clinical symptoms other than the frequent occurrence of maxillary sinusitis. When exposing paranasal formations using X-rays, the doctor can see a rounded shadow of low or medium intensity with an even, clear contour.

Cyst formation in the paranasal sinuses requires surgical treatment.

Fragment of an x-ray of the paranasal sinuses: cyst on the right

How to take an X-ray of PPN: preparation

No special preparation is required to take an x-ray of the sinuses. Before the procedure, metal objects should be removed. The x-ray technician positions the patient vertically to the vertigraph. The nose and chin should be in the same plane (nasomental projection). When styling the chin, the plane of the nose and chin should be at an angle.

In conclusion, I would like to note that an X-ray of a child’s PPN is performed only in extreme cases, when the harm from an undiagnosed disease is stronger than the negative effects of X-rays.

Don't assume that a computed tomography (CT) scan shows more than a sinus x-ray. Each study has its own goals.

When should an X-ray of the PPN be done:

  • for severe headaches;
  • after suffering from a cold;
  • in case of an unexplained increase in temperature;
  • for pain in the forehead after the flu.

X-rays of the nose and paranasal formations are in rare cases supplemented by CT or MRI (magnetic resonance imaging) when a suspicious symptom is identified that cannot be studied in more detail by radiographic methods.

It is not difficult to take an X-ray of the PPN. No preliminary preparation is required. The procedure involves placing a person vertically to the vertigraph. The x-ray technician asks the patient to hold his breath. After pressing the exposure button on the control panel of the X-ray machine and developing the X-ray image of the maxillary sinuses, it is sent to a radiologist for interpretation.

What is sinusitis

Sinusitis is an inflammatory disease. Its danger lies in the fact that the pathology increases intracranial pressure. A person identifies the disease by specific pain sensations in the forehead and paranasal areas.

The danger of the disease is that the inflammatory infiltrate can enter the brain vessels and cause hemorrhage.

What is chronic hypertrophic sinusitis

Chronic hypertrophic sinusitis in the image does not appear as a darkening with a horizontal fluid level, but as a wall layer with an uneven and somewhat concave contour.

The interpretation of such an image is described as follows: on the radiograph, PPN is a parietal darkening due to a hypertrophied and thickened mucous membrane. In some cases, there is a total darkening of the cavity, which becomes completely airless.

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Source: http://x-raydoctor.ru/rentgen/lor/pridatochnye-pazuhi-nosa.html

Darkening of the maxillary sinuses, decreased transparency of the frontal sinus

Related and recommended questions

9 answers

Also, don’t forget to thank your doctors.

ENT6 20:34

ENT8 20:04

ENT2 19:35

I got sick on February 13, 2017

The nose was completely stuffy, the snot was clear at first, but after 2 days it turned bright yellow. Headache, feeling of fullness, increased pain when tilting the head, pressure on the eyes. Burning sensation in the head. It happened that snot flowed straight from the eyes when blowing my nose. They gave me a referral for an x-ray.

The maxillary sinuses are shaded with moderate intensity and the cells of the ethmoidal labyrinth are airy. The nasal septum is slightly curved to the left. Hyperplasia of the nasal mucosa in the lower third. Please help me decipher. What it is? Thanks in advance for your answer!

ENT9 15:41

An 8-year-old child has the following X-ray results: “Darkening of the right maxillary sinus with fluid level. Soft veiling of the parietal left maxillary sinus. Swelling of the nasal mucosa"

Blood tests are attached.

Complaints: nasal voice, very rare purulent discharge that does not come out well. There is no temperature, the general condition is cheerful.

Based on this conclusion, can we talk about sinusitis? Can you recommend a treatment?

Source: http://03online.com/news/zatemnenie_verhnechelyustnyh_pazuh_snizhenie_prozrachnosti_lobnoy_pazuhi/72

Signs and methods of treatment of parietal sinusitis

Treatment of sinusitis is carried out under the supervision of an experienced ENT doctor, so at the first signs of the disease, contact the clinic.

Features of the disease

Chronicity of the disease occurs due to the fact that treatment of the acute stage was carried out untimely or inadequately. This is not surprising, since the symptoms at the initial stage are easily confused with the manifestation of acute respiratory infections or acute respiratory viral infections.

Wall seal

Chronic parietal sinusitis differs from other types of sinusitis. With chronicity, deep inflammation occurs, spreading to both the upper (epithelial) and submucosal layer, as well as to the bony parts of the sinuses.

The inflammatory process leads to swelling of the mucous tissues of the nose, then it rises higher, directly affecting the paranasal sinuses. There is a parietal thickening of the mucous tissue, in simple words, swelling.

No discharge

The peculiarity of this form of sinusitis is the absence of purulent contents in the sinuses. Pathological exudate flows down the posterior wall of the larynx. If there is discharge, it is scanty and does not make a person think about sinusitis. Therefore, the patient carries out treatment inadequately, relying on his own strength, which often leads to aggravation of the disease and the development of complications.

Asymptomatic

Parietal sinusitis is characterized by an asymptomatic course, at least at the initial stage of the disease, when treatment is already required. This is insidious - symptoms appear 2 or even 4 weeks after the disease that caused sinusitis has been eliminated.

Chronic sinusitis is characterized by mild symptoms. Its increase occurs during periods of exacerbation. With relapses of parietal sinusitis, the symptoms are as follows:

  • hyperthermia (increased body temperature), sometimes to critical levels;
  • headaches localized in the frontal part and the paranasal sinuses, a characteristic symptom is increased pain when bending down;
  • pressing, bursting sensation in the nose and eyes;
  • impaired sense of smell, difficulty breathing;
  • deterioration of health, sleep.

During remission, parietal sinusitis is characterized by:

  • absence of temperature (sometimes rises to subfebrile levels);
  • swelling of the face;
  • tearing and redness of the eyes;
  • accumulation of pathological exudate on the posterior walls of the larynx;
  • feeling of a lump in the throat and cough.

People with chronic sinusitis often experience bad breath, especially in the morning.

Treatment of the disease is often carried out untimely, since there are no pronounced pain symptoms, as in the acute form.

Causes

The causative agents are pathogenic microorganisms - staphylococci, streptococci, mycoplasmas, fungi, which easily penetrate a weakened body.

Decreased immunity

Many diseases can provoke a weakening of the body’s defenses, but the precursors of sinusitis are as follows:

  • chronic respiratory infections;
  • previous colds;
  • prolonged rhinitis of an infectious or allergic nature;
  • advanced caries of the teeth of the upper jaw.

Deviated septum

An abnormal anatomical structure of the nasal cavity, for example, a deviated septum or too narrow passages, predisposes to the development of sinusitis.

Complication after a cold

More often, the disease develops as a complication after a cold or other illnesses accompanied by a runny nose. Therefore, acute respiratory infections are treated under the supervision of a doctor; this will help prevent the development of complications such as sinusitis.

If it was not possible to avoid inflammation of the paranasal sinuses, at the first sign, contact an otolaryngologist for conservative therapy.

Treatment methods

Treatment is prescribed by an otolaryngologist after diagnosis. The diagnosis is made based on patient complaints, endoscopy and x-ray examination of the sinuses. Conservative therapy for parietal sinusitis is a set of measures consisting of medications and physiotherapeutic procedures. In rare cases, it is necessary to resort to surgery.

Drainage of secretions

To improve drainage and nasal breathing, decongestant medications are prescribed. These drugs are vasoconstrictors (Noxprey, Evkazolin, Nazivin, Galazolin). The effect occurs after 5-7 minutes, but they should not be abused.

It is not recommended to use decongestants for more than a week; this can lead to the development of atrophy of the nasal mucosa.

Antibiotics

Since sinusitis is caused primarily by bacteria, medications to combat them are systemic or local antibiotics. For sinus infections, drugs from the cephalosporin group are prescribed - Ceftriaxone, Suprax, Cefotaxime. Local medications used intranasally include the following drugs: Isofra, Polydexa, Bioparox.

Natural drops

The results are obtained by using Sinuforte tablets and drops, which are created on the basis of natural ingredients and will not cause harm to the human body. The sinuses are also washed using the Proetz (cuckoo) method with antiseptic solutions - the procedures eliminate inflammation and relieve swelling.

Physiotherapy

In addition to drug treatment, it is recommended to undergo a course of physiotherapeutic procedures. Electrophoresis, laser therapy, electromagnetic waves, and mud therapy enhance the effect of medications, but they cannot be taken during an exacerbation of sinusitis.

Treatment of chronic parietal sinusitis lasts from 2 weeks to 2 months. The sooner you see a doctor, the faster you will get rid of the disease without subsequent chronicity and complications.

Source: http://nasmorklechit.ru/gajmority/gajmorit-pristenochnyj.html

Subtotal darkening of the maxillary sinuses

What is subtotal darkening of the maxillary sinuses? If an x-ray shows a decrease in transparency in the lower and middle parts of the maxillary sinus, this may indicate the presence of infectious inflammation or a benign tumor - a cyst, a polyp. X-rays are prescribed to patients if sinusitis, polypous sinusitis, cancer, etc. are suspected.

X-ray examination of the paranasal sinuses (SNS) allows us to assess the level of pneumatization (presence of air) in the mentioned anatomical structures. The image assesses the degree of inflammation of the maxillary sinuses, i.e. maxillary sinuses, and prescribe adequate treatment. The article discusses the interpretation of radiographs, as well as pathologies that are detected during subtotal and parietal eclipse of bone cavities.

X-ray PPN - what is it?

X-ray PPN is an instrumental method for examining the paranasal sinuses, which makes it possible to identify pathologies in the early stages of development. An X-ray image gives a clear idea of ​​what pathological processes occur in the paranasal sinuses. Transillumination of intranasal structures allows you to determine:

  • degree of inflammation of the mucous membranes;
  • the presence of serous or purulent exudate in the nasal cavity;
  • formation of benign or malignant tumors.

During the examination of the patient, the radiologist takes two pictures - in a supine and standing position. The absence of any pathologies in the maxillary sinuses looks like this on x-ray:

  1. the bone walls of the paranasal sinuses have a clear outline;
  2. the contours of the ethmoid cells located at the level of the nasal septum are not blurred;
  3. Pneumatization of the PPN is no different from the reference one, which is located at the level of the eye orbits.

If, after an instrumental examination, darkened areas are detected in the image, the patient is referred for a computed tomography scan. After an accurate diagnosis, he prepares a suitable drug treatment aimed at eliminating the inflammatory reactions in the maxillary sinuses.

Why is a PPN x-ray prescribed?

In the bones of the skull there are several pairs of air cavities, which are called paranasal or paranasal sinuses (sinuses). Their inner surface is covered with soft tissues, in particular ciliated epithelium. Its inflammation often leads to the development of sinusitis.

Sinusitis is a collective term for a group of respiratory diseases characterized by inflammation of the pelvic floor. Radiologists pay attention to the fact that not every sinusitis is sinusitis. Only when the maxillary (maxillary) sinuses are affected is a diagnosis of “maxillitis” or “sinusitis” made.

X-ray visualization of the maxillary sinus allows us to identify several forms of sinusitis:

An otolaryngologist cannot diagnose “sinusitis” only on the basis of the patient’s medical history and complaints.

When receiving an unclear image, it is impossible to say with certainty that the patient suffers from one or another type of pathology. In this case, the diagnostic examination is supplemented by computed tomography.

What can be seen on an x-ray?

The radiological term “opacification” actually refers to light spots in the sinus cavity. In the absence of pathological processes in the respiratory tract, the maxillary sinuses are quite dark. It is possible to understand that fluid or pus has accumulated in the paranasal cavities only by comparing the shade of the spots inside the bone structures with the spots in the eye orbits. If the shade in the right or left maxillary sinus is lighter than in the orbit, the development of bacterial sinusitis or a cyst is suspected.

As a rule, treatment is prescribed after a specialist makes a puncture in the maxillary sinus if there is pathological content in it. After this, the biomaterial is sent for microbiological examination, based on the results of which the causative agent of the infection is determined. And only after this, the otolaryngologist develops a suitable treatment strategy, prescribes antibiotics, corticosteroids and other drugs.

Interpretation of the radiograph

Even with an X-ray examination of the maxillary sinuses, it is not always possible to say that the cause of pathological symptoms is sinusitis. Deciphering the image requires analysis of a number of anatomical structures:

Deciphering one x-ray takes an experienced specialist no more than 10 minutes of time. If there are obvious dark spots in the bone cavity, the doctor may accidentally diagnose cancer. What does the specialist’s medical report indicate and how is the image interpreted?

  1. exudative maxillitis - light spots with a clear horizontal border in the upper part of the maxillary sinuses;
  2. parietal-hyperplastic maxillitis - parietal darkening in the area of ​​​​the bone walls, associated with swelling of the mucous membrane; the wavy contour of the bone cavity faces the inside of the sinus;
  3. exudative maxillitis - total darkening of the maxillary sinuses associated with the accumulation of fluid in the anatomical structures;
  4. polypous sinusitis - protrusion of the parietal part of the sinus into the bone cavity;
  5. purulent sinusitis - subtotal (almost complete) darkening of one or both maxillary sinuses.

The above transcripts are provided for informational purposes only and therefore cannot be used for independent diagnosis and drawing up a treatment regimen.

Only a doctor can assess the degree of impairment of pneumatization of the maxillary sinus using an x-ray. When making a diagnosis, they take into account structural changes in the ethmoidal labyrinth, as well as the clarity of the contours of a single cell.

What pathologies are detected using X-ray of PPN?

X-ray of the PPN reveals characteristic changes in the intranasal structures. In a healthy person, the paranasal sinuses look like semi-oval dark formations. To identify pathology, you need to compare the degree of their staining with the shade of the eye orbits. Parietal darkening of bone cavities indicates the development of a whole range of respiratory diseases.

Hypertrophic maxillitis

Hypertrophic maxillitis is a chronic inflammation of the maxillary sinus, accompanied by thickening of the mucous membrane. In the image, the pathology does not appear as darkening, but as a wall layer with a ragged, curved edge. The interpretation of the radiographic image is described as follows: parietal darkening of the maxillary sinus due to hypertrophy (thickening) of the mucosa.

If the diagnosis contains the phrase “total darkening,” this indicates a complete violation of the pneumatization of the bone cavity. In other words, the patient is found to have complete obstruction (airlessness) of the maxillary sinus. Treatment of the disease involves the use of antibiotics and nasal corticosteroids. If the pathology has developed against the background of allergic rhinitis, antihistamines are included in the treatment regimen.

Oncological diseases

Transillumination of the maxillary sinuses allows us to determine the presence of benign or malignant tumors in the intranasal structures. By analyzing the x-ray, a specialist can identify:

  • osteoma is a benign neoplasm that occurs in bone tissue; the tumor grows very slowly and almost never becomes malignant, so its course is considered favorable;
  • sarcoma is an actively growing malignant tumor, which consists mainly of connective tissue; the rapid development of pathology leads to the destruction of bone structures in the paranasal sinuses;
  • chondroma - a cartilaginous tumor prone to malignancy (malignancy); It is diagnosed mainly in young children and adolescents.

Benign and malignant tumors are subject to surgical removal and subsequent drug treatment.

Cyst in the paranasal sinuses

As a rule, a cyst on an x-ray is a surprise to a specialist. The process of tumor formation does not cause any discomfort to the patient, so in most cases it is diagnosed accidentally during an endoscopic or radiographic examination.

Spontaneous opening and evacuation of purulent secretion from the cyst into the surrounding tissues can lead to complications. A cyst is a hollow neoplasm containing fluid inside. In the picture, the cyst looks like a rounded small shadow located in the middle or lower part of the maxillary sinus. Treatment of cystic tumors requires surgery.

Exudative sinusitis

If the maxillary sinuses are filled with serous effusions, a horizontal level of fluid will be visible on the x-ray. In most cases, this indicates the development of exudative sinusitis - a respiratory disease in which a lot of fluid accumulates in the maxillary sinuses.

When carrying out differential diagnosis, a puncture is taken from the affected sinus to accurately determine the type of pathology. In otolaryngology, the following forms of sinusitis are distinguished:

  • catarrhal - filling of the paranasal sinuses with serous effusions, accompanied by redness (hyperemia) and swelling of the mucous membrane;
  • hemorrhagic - a dangerous and quite rare form of the disease in which blood accumulates in the maxillary sinuses;
  • purulent - bacterial inflammation of the accessory sinuses, characterized by the accumulation of purulent exudate in the bone cavities.

Hemorrhagic sinusitis is dangerous due to increased vascular permeability, in which infection can easily penetrate the systemic bloodstream.

To treat the catarrhal form of the disease, vasoconstrictor drops (decongestants), mucolytics, antiallergic and antiviral agents are used. Purulent inflammation can be eliminated only by taking systemic antibiotics and local antimicrobial agents.

Conclusion

X-ray of the PPN is one of the most informative methods for examining patients suffering from respiratory diseases. Photographing intranasal structures is not accompanied by excessive radiation load on the body. An X-ray can be considered one of the most reliable methods for early diagnosis of pathologies of the paranasal sinuses.

Subtotal darkening on an x-ray looks like a large bright spot that fills almost the entire cavity of the maxillary sinus. This picture often indicates the presence of fluid or tumor in the maxillary sinuses. In turn, parietal darkening may indicate inflammation of the mucous membrane or the formation of a nasal polyp on its surface.

Author: Irada Huseynova

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What is subtotal darkening of the maxillary sinuses?

Subtotal darkening of the maxillary sinuses - what is it and how dangerous? This conclusion can be heard in various diseases of the ENT organs. In simple terms, it is an inflammation of the mucous membrane of the maxillary sinus with accumulated secretions. An X-ray is often recommended for patients with sinusitis, sinusitis or sinusitis.

Subtotal darkening of the maxillary sinuses - causes

If the doctor sent the patient for an X-ray of the nose, then he suspects inflammation of the mucous membrane with a possible accumulation of discharge or pus. The image shows the maxillary sinuses, frontal and ethmoidal labyrinth. Subtotal darkening of the maxillary sinuses makes it possible to determine the advanced state of the disease. The more shadows there are in the picture, the more purulent masses have already accumulated.

The reason for the accumulation of such secretions is the active reproduction of pathogenic microorganisms. The causative agents of sinusitis or sinusitis are streptococci or pneumococci. They can become active after prolonged rhinitis, when treatment was ineffective or incorrect. With the accumulation of secretions and inflammation of the mucous membrane, severe swelling appears, which does not allow the mass to leave the sinus. Mucus begins to accumulate, which is an ideal environment for the proliferation of pathogenic microorganisms.

Pus accumulates in the maxillary sinuses not only due to a bacterial infection. If the picture clearly shows thickening of the mucous membrane, then this condition could have formed due to:

  • Acute inflammation;
  • Allergy progression;
  • Swelling after sinusitis;
  • Long-term chronic inflammation.

Do not forget that sinusitis or frontal sinusitis can develop due to a cyst, which can also be seen in the image. The causes of darkening are adenoids and polyps. Such formations can provoke frequent runny nose, which over time transforms into sinusitis.

X-ray of PPN for pathology of the maxillary sinuses

X-ray of the paranasal sinuses (PSN) helps to assess the stage of development of sinusitis and sinusitis already at the primary stage of the disease. This diagnostic method is prescribed if:

  1. There is nasal discharge after a respiratory infection;
  2. The discharge does not go away within 7-10 days;
  3. Nosebleeds appear;
  4. The body temperature remains high, but there is no nasal discharge;
  5. Noticed hyperemia or redness of the skin in the paranasal sinuses;
  6. When tilting the head, a pressing pain appears.

Total darkening of the maxillary sinuses indicates severe neglect of the disease, this is especially evident when the frontal sinuses are darkened. At the initial stages of development of sinusitis, discharge accumulates only in the PPN.

If the doctor diagnoses nasal pathologies caused by adenoids, cysts or polyps, then treatment will include surgery. The PPNs themselves in a healthy person are semi-oval in shape, their color matches the color of the eye sockets. At the slightest accumulation of pus or inflammation of the mucous membrane, the doctor notes a parietal darkening.

The X-ray procedure of the PPN is painless. To do this, just position yourself correctly on the device stand. The patient's position depends on the type of projection indicated by the doctor. The radiologist must indicate the correct position. Often, patients, either in a vertical or horizontal position, press their nose and chin tightly against the apparatus stand. It is enough to fixate for a few seconds to get a clear image.

X-rays during this procedure can range from 0.12 to 1.18 mSv, the amount of mSv depends on the type and power of the equipment used. Relatively small doses of x-ray radiation are unacceptable for pregnant women and preschool children. For women in this position, rays can affect the development of the fetus, and in a child under 6 years of age they cause changes in the bone tissue of the skeleton, so doctors prescribe such a study as a last resort.

What can be seen on an x-ray?

The healthy nasal cavity in the image has a clear border and an average thickness of the walls of the nasal cavity. When X-raying the maxillary sinus with suspicion of the initial stage of sinusitis, radiologists note thickening of the affected contours. This condition is characterized by the appearance of inflammation of the mucous membrane.

The ethmoid labyrinth is also visible in the image, because in this structure the accumulation of secretions occurs first. If darkening is not visible, then it is important to carefully examine the structure of the ethmoid bone tissue.

Infiltration or pus often causes the so-called “milk in a glass” symptom. This name comes from the property of the discharge to always be located in a horizontal position, no matter what position the patient occupies. Darkening with this symptom is either unilateral or bilateral. If the disease is advanced, then the accumulation of pus becomes total. This condition is fraught with the spread of purulent masses into neighboring tissues and vessels. There is an increased risk of infiltrate penetrating into the brain, which causes meningitis. When pus enters the bloodstream, it causes sepsis and inflammation of internal organs.

Accumulation of exudate with subtotal and total darkening also develops with the appearance of dense neoplasms in the nasal cavity, for example, chondroma, osteoma or sarcoma. Such cells may have a dense outer shell, but inside they will have a liquid consistency.

Interpretation of the radiograph

When a doctor reads a picture of suspected sinusitis, the nasomental projection shows a darkening with an upper horizontal level. The liquid will be displayed on a dark background with a light outline. In advanced forms of the disease, darkening appears above the nose. If shadows are observed in several cavities at once, then the patient is no longer dealing with sinusitis, but with frontal sinusitis.

When the contour of the mucous membrane is wavy, there is a high probability of hyperplastic sinusitis. To diagnose tumors, x-rays are recommended to be performed with contrast. Any cysts or tumors will appear with a pronounced rounded outline.

If sinusitis develops due to allergies, then the image will have additional formations in the form of a “plus shadow”. This condition occurs due to severe protrusion of the mucous membrane. Additionally, photographs with pronounced fractures of the bone tissue of the nose or the presence of a foreign body in the nasopharynx help to diagnose sinusitis.

Conclusion

The image taken must be read by both the radiologist and the otolaryngologist. If sinusitis is diagnosed at the initial stage, then treatment consists of using vasoconstrictor drops, painkillers, and rinsing the nasal cavity with aseptic solutions. When the prescribed therapy does not give a good result, it is important to use antibiotics.

In advanced conditions, doctors suggest puncturing the sinus to quickly remove the contents. The puncture is also carried out for diagnostic purposes to identify the nature of the appearance of discharge. Treatment is often based on antibiotics, as well as physiotherapeutic procedures.

X-rays in the treatment of sinusitis or sinusitis are a common procedure, because in a short time the doctor is given the opportunity to see the full depth of tissue damage. To get a clear image, you need to follow all the recommendations of the radiologist.

Source: http://stopillness.ru/chto-takoe-subtotalnoe-zatemnenie-gajmorovyh-pazuh/

Features of the course of parietal sinusitis, diagnosis and treatment

Parietal sinusitis is an inflammatory pathology of the maxillary sinus. As an independent disease, it does not develop, but is a consequence of acute processes in the nose and nasopharynx. It can be one-sided or two-sided. The trigger mechanism of the disease is untreated rhinitis or sinusitis, lack of necessary sanitation of the upper respiratory tract, as a result of which bacterial mucus accumulates and stagnates in the sinuses. This creates favorable conditions for structural changes in the mucous membrane. Swelling appears and the functionality of the ciliated epithelium is disrupted.

Causes and predisposing factors for the development of pathology

The most common reason for the development of the disease is the introduction of infectious agents. Pathogens that cause inflammation of the maxillary sinuses:

The formation of parietal sinusitis begins after acute inflammatory processes:

Predisposing factors include chronic allergic reactions – hay fever, prolonged runny nose. Changes in the condition of the inner wall of the maxillary sinus can develop against the background of constitutional abnormalities - narrowing of the nasal passages, curvature of the nasal septum, proliferation of cartilaginous tissue, multiple polyps in the mucous membrane.

The development of the disease is influenced by the general condition of the patient and the following factors:

  • immunodeficiency conditions - HIV, AIDS;
  • hypovitaminosis;
  • mechanical and barotrauma;
  • chronic pathological foci - caries, adenoids;
  • long-term treatment with chemicals - antibiotics, immunosuppressants, hormones;
  • in babies - when teething.

Pathogenesis and clinical picture of the disease

The disease develops in the autumn-winter period, when the human body is weakened and respiratory viral infections often occur.

Against the background of prolonged inflammation, parietal edema of the maxillary sinus mucosa appears. The ciliary layer increases, its relief is smoothed. Gradually, the mucous membrane thickens and becomes denser, becoming covered with thick, difficult to separate sputum.

The nature of the pathological exudate is serous. Rarely does mucus and pus form. The paranasal sinuses are not completely blocked, so in patients the signs of the disease are less pronounced than with acute sinusitis. Most often one side is stuffy, the runny nose is not intense. Only in case of complications does rhinorrhea with purulent contents appear, and the bacterial infection spreads to both sinuses.

Aching pain appears in the upper jaw area. It can radiate to the frontal part of the head, brow ridges, and temples. The nose, upper and lower eyelids, and cheeks swell.

With chronic parietal sinusitis, a dry cough sometimes develops, which becomes chronic. In the morning it intensifies due to stagnant processes.

Blockage of the nose leads to insufficient respiratory function, a feeling of heaviness in the maxillary sinuses, which intensifies when the head is tilted. Symptoms of complications may develop - inflammation of the middle ear, congestion in the ear canal, hearing loss.

The disease worsens the general condition of the patient. This is manifested by the following symptoms:

  • loss of appetite due to impaired sense of smell;
  • loss of strength, fatigue, decreased ability to work;
  • headache;
  • emotional instability.

During periods of exacerbation, body temperature rises to subfebrile levels (37.5°C), mucus secretion in the nose and sinuses increases, and headaches intensify. Photophobia appears and lacrimation increases. Nasal congestion is severe and persistent.

Methods for diagnosing the disease

When a patient comes to the clinic, the doctor initially collects anamnesis and performs a rhinoscopy - examination of the nasal passages using special mirrors and artificial lighting.

Before the manipulation, the outer part of the nose and wings are palpated, and the vestibule is examined. Then they begin the instrumental examination. Rhinoscopy determines the color and condition of the mucous membrane, its integrity, and structural changes. Parietal sinusitis is characterized by pallor of the epithelium or slight hyperemia, swelling, and thinning of the blood network. The nature and amount of exudate is also assessed.

The modern method for diagnosing sinusitis is endoscopy. During the examination, the image is projected onto the monitor, allowing you to accurately determine pathological changes in the epithelium, the degree of the inflammatory process, the presence of polyps and other neoplasms in the nose.

In case of sinusitis, radiography is mandatory. Interpretation of the image when parietal sinusitis is detected:

  • decreased pneumatization of the maxillary sinus (air filling);
  • parietal darkening of the maxillary sinuses;
  • analysis of the condition of facial bones, eye orbits.

If there are difficulties in making a diagnosis, the patient is prescribed a computed tomography scan. This is a highly informative examination method that will allow you to examine in great detail the structural changes in the sinus mucosa, detect deformation, compaction, and inflammation.

MRI of the nose and sinuses for chronic sinusitis is indicated only if there are suspicions of constitutional abnormalities or the presence of neoplasms.

Methods for treating parietal inflammation of the nasal sinuses

Treatment for parietal sinusitis is conservative. To eliminate a chronic inflammatory process, an integrated approach is needed, which includes sanitizing the sinuses, taking anti-inflammatory drugs, antibiotics if indicated, and physical therapy.

Before using pharmacological drugs topically, thoroughly rinse the nose and sinuses to remove accumulated mucus. Disinfection of the mucous membrane is carried out using solutions based on sea salt - Salin, Aqua Maris, No-Sol, Humer. You can also use normal saline solution - 0.9% NaCl.

During the period of exacerbation, with severe runny nose, vasoconstrictor nasal drops or sprays are prescribed - Naphthyzin, Galazolin, Ximelin, Nazivin.

To relieve swelling and restore patency of the upper respiratory tract, antihistamines are indicated - Loratadine, Desloratadine, Tavegil, Cetirizine.

In severe chronic forms of the disease, hormonal drugs for topical use Nasonex, Avamis (nasal suspensions) are prescribed.

Antibiotics are prescribed when a sinus infection is confirmed by laboratory methods. Macrolides (Azithromycin) or penicillins (Amoxiclav, Amoxicillin) are prescribed orally for systemic use. For local effects on the bacterial flora, Isofra (framycetin) and Polydexa (neomycin) sprays are used.

If the patient has severe pain, he is prescribed anti-inflammatory drugs - Ibuprofen, Diclofenac, Nimesil, Nise.

In order to dilute and remove viscous mucus, take homeopathic remedies Euphorbium Compositum and Sinupret.

To speed up the elimination of edema and restore the functionality of the epithelium, patients are prescribed physiotherapeutic procedures - UHF, laser, ultrasound.

You cannot warm up your sinuses on your own at home. This can increase the proliferation of microbes and the spread of infection to nearby organs, and increase swelling.

The duration of drug treatment is 2-4 weeks, depending on the severity of the disease.

The prognosis of the disease is conditionally favorable. After treatment, patients fully regain their ability to work and physical activity. Parietal sinusitis does not pose a serious health hazard if treated promptly and adequately. Complications are extremely rare.

Source: http://pulmono.ru/nos/gajmorit/osobennosti-techeniya-pristenochnogo-gajmorita-diagnostika-i-lechenie