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Write a Testimonial Few good words, go a long way, thanks! Personalize Gift card We will send an email to receiver for gift card. Continue Shopping Checkout. Reset Pincode. Submit a Review. Modern Head And Neck Imaging. JK Rowling. Click on below image to change. Click on image to Zoom. Average Rating Customers. Sorry, out of stock. Description A comprehensive overview of the state of the art in imaging of the head and neck. Submit Review Submit Review. An expanded, completely opacified cell is a mucocele. The obstruction to the sinus ostium may be benign, such as fibrous dysplasia, or malignant, as in a sinonasal squamous cell carcinoma.
The goals of CT or MRI in this setting include careful assessment of the sinus ostium to determine the cause of the obstruction, and assessment of the sinus or cell walls to detect intraorbital or intracranial extension.
The content of the mucocele or the thinned wall usually has a smooth interface with the dura or periorbital fat. This characteristic lack of a feathery interface implies that the process may be intracranial or intraorbital, but is extradural and extraconal, without dural or intraconal extension.
Adult male with chronic sinusitis and headaches. Right frontal sinus mucocele. A , Axial noncontrast CT shows a well-circumscribed extra-axial right frontal mass that is homogeneously mucoid density. B , Bone algorithm axial image shows the walls of the mucocele arrows are thin, deossified, and probably completely dehiscent. Note opacified left frontal sinus, without expansion or dehiscence of the walls. Signal intensity SI within the mucocele on MRI is variable depending on how long the sinus or cell has been obstructed, and the relative water vs protein concentration of the contents.
In fact, the intensity on T2 can be so low that the cell appears air filled and not opacified.
Generalized skull base thinning, deossification, and osseous dural defects, with or without meningoencephaloceles, are common in the female patient with elevated body mass index. Take a Test. There is diffuse thin non-nodular dural enhancement arrows of the entire left cerebral hemisphere, likely a combination of meningeal edema and possibly subdural pus. Human papillomavirus and head and neck cancer. Central skull base chordoma.
There is usually thin smooth enhancement of the mucoperiosteum lining the mucocele. Fifty-year-old male with left proptosis and headache. Left frontoethmoid mucocele. A , Coronal bone algorithm CT shows complete destruction of the left ethmoid roof, and lamina papyrecea, by a soft tissue mass.
On the right, note the normal cribriform plate small arrow and ethmoid roof longer arrow. There is a smooth interface with the brain suggesting the dura is intact. Note lateral displacement of the left medial rectus muscle long arrow and superior oblique muscle arrowhead. More medially the dura is thinned and possibly dehiscent, as the black line is not preserved small arrow. There is still a smooth interface with the gyrus rectus, and no vasogenic frontal lobe edema. Local complications of bacterial sinusitis, mastoiditis, and less commonly severe facial infections include osteomyelitis, epidural abscess, subdural empyema, meningitis, ventriculitis, and cerebritis.
Ultimately, a discrete intra-axial brain abscess can develop, which may be in close proximity to the infected sinus or mastoid or even remote, as the infection can extend hematogenously. MRI with Gd shows thickened and enhancing leptomeninges, and ependymal enhancement when there is ventriculitis. The classic appearance of a brain abscess is a ring-enhancing mass, with a rim of low SI on T2-weighted images. Advanced imaging techniques, such as perfusion imaging and diffusion tensor imaging, 4 have been described but are usually not necessary as the clinical presentation is generally unequivocal.
Adult patient with several weeks of sinusitis, now with severe headache, seizures, and altered mental status. Bacterial frontal sinusitis with intracranial abscess. A , Axial CECT shows a peripherally enhancing left frontal intra-axial mass arrows with surrounding vasogenic edema short arrows.
Note opacified frontal sinus.
B , Bone algorithm CT confirms opacified frontal sinus, but the posterior wall is intact arrows. The infection can extend from the sinus intracranially presumably through venous channels, without destroying the posterior wall. C , Axial T2-W FS image shows boggy edema in the left forehead and the completely opacified frontal sinus, filled with hyperintense debris and pus.
The abscess has a low SI rim arrows , a characteristic appearance for brain abscess on T2 images. D , Axial T1-W Gd-enhanced image shows the peripheral enhancement of the abscess capsule, the central debris and pus, and surrounding vasogenic edema. There is diffuse thin non-nodular dural enhancement arrows of the entire left cerebral hemisphere, likely a combination of meningeal edema and possibly subdural pus.
E , On this diffusion image notice the markedly restricted diffusion in the abscess arrows , a characteristic of brain abscess. There is artifact at the posterior frontal sinus wall and the frontal lobe, a limitation of diffusion imaging at any bone—brain interface.
Venous thrombosis, either cortical vein or major sinus, is a potential serious complication of bacterial sinusitis or mastoiditis. Because sinus thrombosis is often catastrophic, with cerebral edema, hemorrhage, and infarctions as potential complications, early suspicion and imaging is stressed. Use of thrombolytics and even mechanical clot removal are controversial. Because venous thrombosis and especially cavernous sinus thrombosis are rare, prospective comparisons of treatment are not available.
Adult patient, immune deficient following treatment for leukemia, now has new neurological deficits with limited ocular motility on right.