11/11/2023 0 Comments Maxillary sinus barotraumaMucosal edema and some bleeding may occur ( 1) but are less prominent than in the squeeze situation. When the ambient pressure decreases, the pressure inside the affected sinus remains relatively high, sometimes referred to as the “reversed squeeze.” When a defect in the sinus wall exists ( 1, 4, 5), the positive pressure may result in pneumocephalus, periorbital or orbital emphysema, and, rarely, meningitis. Rapid decrease in ambient pressure is a much less common cause of sinus barotrauma with different mechanism and results. Comparable with the findings described above, these include mucosal thickening, fluid levels, polypoid masses, and complete sinus opacification. Radiologic reports of sinus barotrauma are scarce and include only plain film records ( 1– 3, 5). Referred pain and numbness may occur as a result of pressure on branches of the trigeminal nerve in the maxillary sinus ( 5). This may cause pain, sometimes abrupt and severe, and possible epistaxis. The pressure in the obstructed sinus remains relatively low, resulting in a vacuum effect, sometimes referred to in the literature as “the squeeze.” This vacuum effect may be stressful to the sinus mucosal lining and may cause mucosal edema, serosanguineous exudate, and submucosal hematoma. Rapid increase in ambient pressure, as in airplane or diving descent, is the most common mechanism. This occurs most commonly in flight passengers and scuba divers. Sinonasal barotrauma is the result of a rapid change in ambient pressure that is associated with sinus outflow compromise, such as inflammatory mucosal thickening, polyps, and/or structural deviations ( 1– 5). The mass was hyperintense on both T1- and T2-weighted images and did not enhance with the administration of contrast agent. Additionally, a polypoid mass was present in the right frontal sinus ( Fig 1). It revealed only a large typical developmental venous anomaly, originating from the subependymal veins of the superior aspect of the right lateral ventricle, with no other brain abnormalities (not shown). Because of the history of vascular malformation, MR imaging was performed 1 week after the incident. ![]() The remaining results of the examination were normal. The nasal mucosa was edematous and inflamed. Physical examination, including nasal endoscopy, revealed a deviated nasal septum and hypertrophy of the inferior conchae. There was no history of recent upper respiratory tract infection or previous sinonasal disease. Previous MR images and medical records were not available. The patient’s medical history was remarkable for a right-sided vascular malformation of the brain that was discovered 13 years before the episode reported herein, after a different type of headache, which had not recurred. The pain gradually improved, disappearing after a few hours. ![]() We present a case of frontal sinus submucosal hematoma secondary to barotrauma and report the associated MR imaging findings.Ī 43-year-old man experienced abrupt and severe right-sided frontal headache that occurred with the descent of a commercial jet airplane and became excruciating at the time of landing. Radiologic correlations are scarce and include only plain film records. Divers and aviators are the two main populations that are affected by barotrauma. In the presence of compromise to the normal sinus outflow, a pressure gradient occurs, which is the basic cause of the traumatic event. Sinonasal barotrauma is caused by a rapid change of ambient pressure. To our knowledge, this is the first case of sinus barotrauma described in the radiologic literature and the first to describe the associated MR imaging findings. A mass lesion in the frontal sinus, consistent with submucosal hematoma secondary to barotrauma, was thought to be the cause of the headache. MR imaging was performed because the patient had a history of vascular malformation and revealed an incidental venous angioma. Summary: We present the case of a flight passenger who experienced acute and severe headache during landing.
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