Section 1

A 30-year-old gentleman complains of a year long history of bilateral nasal obstruction and reduced sense of smell.


Describe what type of image this is.

CT scan of sinus, coronal view with contrast

Describe what is shown.

  • Pansinusitis

What is the likely diagnosis?

Chronic rhinosinusitis

What is the diagnostic criteria and what are the two subtypes?

  • According to the EPOS guidelines 
    • Inflammation of the nose and the paranasal sinuses characterised by two or more symptoms, one of which should be either nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior nasal drip)  ± facial pain/pressure  ± reduction or loss of smell AND
    •  either endoscopic signs of: nasal polyps/ mucopurulent discharge / oedema or mucosal obstruction AND/OR CT changes – mucosal changes within the ostiomeatal complex
    • Lasting more than 12 weeks
  •  Chronic rhinosinusitis without nasal polyps
  • Chronic rhinosinusitis with nasal polyps

Describe 3 management options.

  • Conservative: nasal douching
  • Medical: Nasal steroids, antibiotics, antihistamines
  • Surgical: Functional endoscopic sinus surgery

Supporting Information

EPOS guidelines 2020
https://pubmed.ncbi.nlm.nih.gov/32226949/ 

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