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An Unusual Case of Maxillary Sinus Cholesterol Granuloma Showing FDG Uptake on PET/CT

Naoki Umeda, Masaki Hayama1, Akiko Nakamura1

  • 1From the Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine.

Clinical Nuclear Medicine
|October 8, 2020
PubMed

Insights

Cholesterol granuloma (CG) is rare in paranasal sinuses but can show 18F-FDG uptake on PET/CT scans. This case highlights imaging features and diagnosis of maxillary sinus CG.

Area of Science:

  • Otorhinolaryngology
  • Diagnostic Imaging
  • Pathology

Background:

  • Cholesterol granuloma (CG) commonly affects the middle ear.
  • Paranasal sinus involvement by CG is infrequent.
  • Accurate diagnosis of paranasal sinus CG can be challenging.

Observation:

  • A 76-year-old male presented with persistent epistaxis.
  • PET/CT revealed abnormal 18F-FDG uptake in the maxillary sinus.
  • CT imaging was inconclusive, while MRI showed characteristic high T1 and T2 signal intensities.

Findings:

  • Nasal endoscopy identified a hemorrhagic granulomatous lesion in the maxillary sinus.
  • Endoscopic sinus surgery facilitated tissue sampling.
  • Histopathological examination confirmed Cholesterol Granuloma.

Implications:

  • This case expands the understanding of CG presentation in the paranasal sinuses.
  • Highlights the utility of advanced imaging like PET/CT and MRI in diagnosing rare sinus pathologies.
  • Emphasizes the importance of surgical biopsy for definitive diagnosis of challenging sinus lesions.

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