Rhinologic changes in Wegener's granulomatosis

Twenty-eight patients with a clinical diagnosis of sinonasal Wegener's granulomatosis were referred for imaging during the period 1990-2001. Of these, 10 had clinical symptoms and signs confined to the nose and sinuses and 18 had classical systemic Wegener's. The computed tomography (CT) and magnetic resonance (MRI) scans of the series were reviewed by a panel of one otolaryngologist and two radiologists. From the total of 28 patients, 85.7 per cent showed non-specific mucosal thickening in the nasal cavity or paranasal sinuses, 75 per cent showed evidence of bone destruction, and 50 per cent new bone formation in the walls of the sinus cavities. In addition the orbit was affected in 30 per cent of patients. The diagnosis of systemic Wegener's granulomatosis is made clinically but the condition may present characteristic features on imaging by CT and MRI. In a patient without a history of previous sinonasal surgery, a combination of bone destruction and new bone formation on CT is virtually diagnostic of Wegener's especially when accompanied on MRI by a fat signal from the sclerotic sinus wall. These changes are important diagnostically in localized sinonasal Wegener's granulomatosis where the clinical diagnosis may be uncertain and the cANCA test can be negative.