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Medical Forum / Diseases and Disorders / Sinusitis / February 2006Sinus CT Scan - Pictures
I got a sinus cat scan because of constant pressure above the roof of my mouth. I am not sure if the radiologist looked at it, and if they did they did not give their impressions. I received a disc with the images, however. My appointment with the ENT to get diagnosed is not for another week, and I am getting very anxious to know the results. Could anyone provide some insight? Here are the images (use Page Up and Page Down keys to flip through): http://home.comcast.net/~mike5566/ All standard disclaimers apply, I know not to trust advice given on the internet, etc. This is only to ease my mind until my appointment with the ENT. P.S. Tilt was -21.5 degrees, if that helps any. > I got a sinus cat scan because of constant pressure above the roof of my > mouth. I am not sure if the radiologist looked at it, and if they did they [quoted text clipped - 9 lines] > internet, etc. This is only to ease my mind until my appointment with the > ENT. Pansinusitis, left>re. The mucus membranes in your left nasal cavity also quite swollen, you probably have a cold. On 2/2/06 5:28 AM, in article 1ha4ypo.1w02qhj1721d4wN%rlaughton@invalid.com, >> I got a sinus cat scan because of constant pressure above the roof of my >> mouth. I am not sure if the radiologist looked at it, and if they did they [quoted text clipped - 13 lines] > The mucus membranes in your left nasal cavity also quite swollen, you > probably have a cold. Doesn't look too bad, looks like the kind tha clears with medication. A caution is in order. The radiologist's report and the informal comments here are just a rough starting point - they are not medical opinions. A medical opinion can only given when the sinus specialist studies the original images in connection with an endoscopic exam. > A caution is in order. Always a good idea. > The radiologist's report and the informal comments here are just a rough > starting point - they are not medical opinions. Gee thanks for cutting me some slack here. :-/ > A medical opinion can only given when the sinus specialist studies the > original images in connection with an endoscopic exam. Huh? Do you really think one can only diagnose a sinusitis by endoscopy? Normally a simple x-ray is sufficient. We're talking about a simple infection or inflammation of the sinuses here, not cancer. CT is already over-the-top as far as rad. dose to the lenses go, it should be reserved for difficult cases. If the sinusitis doesnt improve after treatment THEN the endoscopy and maybe the CT is justified, both time-wise and radiation-wise. RL >>A caution is in order. > [quoted text clipped - 12 lines] > Do you really think one can only diagnose a sinusitis by endoscopy? > Normally a simple x-ray is sufficient. For sinusitis, the percentage of false positive results from X-rays is known to be roughly around 40%, compared with around 10% for CT scans. medind.nic.in/ibd/t04/i1/ibdt04i1p9o.pdf > If the sinusitis doesnt improve after treatment THEN the endoscopy and > maybe the CT is justified, both time-wise and radiation-wise. In today's managed care, patients typically get referred to ENTs only after multiple courses of antibiotics and steroids have failed.  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > >>A caution is in order. > > [quoted text clipped - 15 lines] > For sinusitis, the percentage of false positive results from X-rays is > known to be roughly around 40%, compared with around 10% for CT scans. Probably because so few radiologists get to see them anymore.. > medind.nic.in/ibd/t04/i1/ibdt04i1p9o.pdf > [quoted text clipped - 3 lines] > In today's managed care, patients typically get referred to ENTs only > after multiple courses of antibiotics and steroids have failed. It'll pass. We're only beginning to find out the long-term effects of all this AB use in kids. As for steroids in kids, or steroids for adult sinusitis that matter.... ridiculous. RL >> A caution is in order. >Always a good idea. > >> The radiologist's report and the informal comments here are just a rough >> starting point - they are not medical opinions. >Gee thanks for cutting me some slack here. :-/ Oh I was not directing my comments at your posts at all. >> A medical opinion can only given when the sinus specialist studies the >> original images in connection with an endoscopic exam. [quoted text clipped - 4 lines] >We're talking about a simple infection or inflammation of the sinuses >here, not cancer How are your ever 100% sure until you examine the patient? >. CT is already over-the-top as far as rad. dose to the >lenses go, it should be reserved for difficult cases. >If the sinusitis doesnt improve after treatment THEN the endoscopy and >maybe the CT is justified, both time-wise and radiation-wise. I was not advocating the CT. It was already done. I was just saying do not rely on it *alone* until the physician sees it and interprets in conjunction with a nomal clinical visit and pateint history. Nasal endoscopy is done routinely now. Pehaps you have experience in other fields where it is more difficult? In any case, I was just using it as an example of something that would be done by the physician, that the radiologist cannot do. I was mostly just talking about terminology, in case the original poster thought (or was that you - I have lost track) he was done now. > >> A caution is in order. > >Always a good idea. [quoted text clipped - 15 lines] > > How are your ever 100% sure until you examine the patient? Well I learnt this stuff in the country hospital setting, where one can still chat with the patients.. The X-ray alone is too little. Of course if the referring colleague has take the time to include a good history then its easy. > >. CT is already over-the-top as far as rad. dose to the > >lenses go, it should be reserved for difficult cases. > >If the sinusitis doesnt improve after treatment THEN the endoscopy and > >maybe the CT is justified, both time-wise and radiation-wise. > > I was not advocating the CT. It was already done. I realize that, you were advocating the endoscopy. > I was just saying do not > rely on it *alone* until the physician sees it and interprets in conjunction > with a nomal clinical visit and pateint history. See above > Nasal endoscopy is done routinely now. Pehaps you have experience in other > fields where it is more difficult? In any case, I was just using it as an > example of something that would be done by the physician, that the radiologist > cannot do. It was a few years ago, nasal endoscopies were not routine (in fact they were quite traumatic and thus seldom used) in that setting. The radiologist diagnosed, his words were chiselled into stone and formed the basis of the therapy. We were the diagnostic gods.. :-/ Nowdays all you get from them are 'impressions', it seems (do they train in art galleries?) Ray >I got a sinus cat scan because of constant pressure above the roof of my >mouth. I am not sure if the radiologist looked at it, and if they did they [quoted text clipped - 11 lines] > >P.S. Tilt was -21.5 degrees, if that helps any. I just saw the ENT about virtually the same thing yesterday. My films look about like yours and I have some major nasal polyps that are going to have to come out. He explained to me that the dark areas are good and the light areas in the sinuses represent obstructions. My guess is that you have one nostril just about completely clogged and the other less so? FWIW YMMV >From an absolute layman's perspective--------- On 0032 and 0033, your lower septum looks deviated to the left. This may be contributing to the bad swelling on the left side. It also looks like something is going on in the left maxillary. Do you have tooth pain in your left upper teeth (molar region)? The left ethmoids also looked like a bit of something was going on. To what degree, i don't know. The ethmoids are hard to judge for this layman. > I got a sinus cat scan because of constant pressure above the roof of my > mouth. I am not sure if the radiologist looked at it, and if they did they [quoted text clipped - 9 lines] > internet, etc. This is only to ease my mind until my appointment with the > ENT. [Disclaimer: I'm NOT a doctor or radiologist, just a patient who's been there, done that] What I see looks like sinusitis, particularly on your left side. The rule of thumb is that the black areas represent wide open space (which is what you want to have in your sinuses); the white/light-gray areas represent tissue or fluid (which you don't want filling up your sinuses). So what I see is: Left ethmoid sinuses whose ducts are almost completely blocked by polyps and cysts. Significantly thickened sinus linings suggestive of inflammation and perhaps infection. And you've got a large polyp in your left maxillary sinus, which I think is blocking the duct from draining. Your right side doesn't look too bad though. You have a deviated septum, but it's not as deviated as mine was. From this CT scan , I'll bet your symptoms are mostly on your left side--feeling of stuffiness, particularly above the left side of the bridge of your nose. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > > I got a sinus cat scan because of constant pressure above the roof of my > > mouth. I am not sure if the radiologist looked at it, and if they did they [quoted text clipped - 31 lines] > side--feeling of stuffiness, particularly above the left side of the > bridge of your nose. I called today and found out that the radiologist did in fact give impressions, I just needed to go and pick them up. Here they are: http://home.comcast.net/~mike5566/impressions.html I'm not sure what any of that means, but I'm very relieved to know I'm not imagining it. This has been going on for several years, a feeling of pressure behind my nose and above my left molars. I had gotten tested for TMJ, had an MRI done on my brain, and gotten a laryngoscopy, none of which showed any problems. Thanks to all who took the time to respond, it is nice to have a second opinion. >>>I got a sinus cat scan because of constant pressure above the roof of my >>>mouth. I am not sure if the radiologist looked at it, and if they did [quoted text clipped - 57 lines] > Thanks to all who took the time to respond, it is nice to have a second > opinion. I think you should make sure that your ENT looks at these films himself, and doesn't rely on the radiologist's opinion alone. I'm more interested in what your ENT has to say than what the radiologist has to say. Because your ENT can combine what he sees on the CT scan with everything else he knows about you--patient history, other tests--to make a more precise diagnosis. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. The images you posted do not have Left and Right labeled. They were obtained coronally, presumably with you laying on your stomach with your chin up. Most CT scanners "flip" the images in that case. Based on the reading by the Radiologist, the images are indeed "flipped". When printed out, the images would normally be as if you were looking at the patient (the patient's left is on your right). Since they were not flipped in your jpeg images, the patient's left is on your left. Therefore, you have more mucosal thickening in your RIGHT maxillary sinus, not your left. To respond to multiple prior posts, the Radiologist is a doctor. His or her reading is correct and appropriate. It is not "gobbledy-gook". It is appropriate communcation between him/herself and the ordering physician. Most ENT's will also look at the images themselves. "A picture is worth a thousand words." An MRI of the brain is not an MRI of the sinuses. While the sinuses are sometimes seen on an MRI of the brain, they are not evaluated in detail and would not usually be commented on, except where there are striking abnormalities. MRI is in general very tailored to the body part in question. For instance a foot and an ankle are two totally different studies in MRI. If your ENT wants an MRI of the sinuses, they could of course order one. However, CT is usually the preferred test, and for most people, MRI would not add anything. -Rich > The images you posted do not have Left and Right labeled. They were > obtained coronally, presumably with you laying on your stomach with [quoted text clipped - 5 lines] > Therefore, you have more mucosal thickening in your RIGHT maxillary > sinus, not your left. Um, his problems are mainly left-sided.. The report also noted the anomalies were mainly on the left. > To respond to multiple prior posts, the Radiologist is a doctor. Right, so what else is new..? > His or her reading is correct and appropriate. It is not "gobbledy-gook". > It is appropriate communcation between him/herself and the ordering > physician. Then this communication should be privy to those individuals and not handed to the patient or placed on the internet for discussion. In the time it takes for a lay-person to find out what its all about he could be half-way through treatment for his sinusitis.. >Most ENT's will also look at the images themselves. "A picture > is worth a thousand words." But only to those who understand what they see.. > An MRI of the brain is not an MRI of the sinuses. While the sinuses are > sometimes seen on an MRI of the brain, they are not evaluated in detail > and would not usually be commented on, except where there are striking > abnormalities. MRI is in general very tailored to the body part in > question. The report may be, but the imaging is not so selective.. Which is what I meant. Had there been something abnormal in the sinuses that are often imaged with the brain (sphenoid, ethmoids, frontal) then I'm sure it would have been commented on. > For instance a foot and an ankle are two totally different > studies in MRI. > > If your ENT wants an MRI of the sinuses, they could of course order > one. However, CT is usually the preferred test, and for most people, > MRI would not add anything. I'm sure its not needed, the CT imaging was quite informative. :-/ If easily available I'd rather use the MRI than CT in pediatric sinuses though.. Ray I'm absolutely impressed by the responses here. I looked at the images too, but all I can see is adjacent humming birds taking nectar out of a couple of flowers. ...Jon |
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