Antrokoanal polip

Özet

Antrokoanal polip, maksiller sinüs mukozasından köken alıp doğal veya aksesuar ostiumdan nazal kaviteye ve koanaya uzanan benign polipoid lezyondur; çocuk ve genç erişkinlerde tek taraflı burun tıkanıklığıyla görülebilir. Kontrastsız ince kesit BT, kistik antral bileşeni, ostiumdan geçen nazal bileşeni ve posterior uzanımını göstererek kökeni ortaya koyar. Kemik erozyonu veya ekspansiyon tipik olmadığından agresif kemik yıkımı başka bir tanıyı gündeme getirmelidir. Koanaya uzanan kısmı fark edilmezse nazofarengeal kitle sanılabilir, antral köken atlanırsa lezyonun tüm yayılımı eksik tanımlanabilir.

Faz ve pencere

Kontrastsız tanısal

Koronal ve aksiyel ince kesitlerde maksiller sinüsü dolduran yumuşak doku, ostiumdan orta meatusa geçen dar bileşen ve posterior koanaya uzanım görülür; kemik korteksi çoğunlukla korunur.

Önerilen pencereler: Yumuşak doku (G 400 / M 40), Kemik (G 1800 / M 400).

BT bulguları

• Tek taraflı, maksiller sinüs içinde kistik ya da yumuşak doku yoğunluklu antral bileşen.
• Doğal veya aksesuar maksiller ostiumdan orta meatusa uzanan devamlı polip gövdesi.
• Orta konkayla lateral nazal duvar arasından geçerek posterior nazal kaviteye ilerleme.
• Posterior uzanım koanayı kısmen ya da tamamen doldurabilir ve nazofarenkse ulaşabilir.
• Sinüs duvarında kortikal destrüksiyon veya belirgin ekspansiyon olmaması benign polip örüntüsünü destekler.
• Antral kistik bölüm ile nazal solid polipoid bölüm aynı lezyon boyunca izlenebilir.
• Ostiomeatal kompleks tıkanıklığına bağlı aynı tarafta eşlik eden mukozal hastalık görülebilir.

Normalde

Maksiller sinüs lezyonu ostiumdan nazal kaviteye uzanır ve tipik olarak komşu kemiklerde erozyon veya ekspansiyon gözlenmez.

Ayırıcı tanı

Retansiyon kisti

sinüs içinde kubbe biçimli kalır ve ostiumdan koanaya uzanmaz.

Sinonazal inflamatuvar polip

sıklıkla iki taraflı ve çoklu; belirgin tek taraflı antral-koanal yol göstermeyebilir.

İnverted papillom

kraniyal taban dahil lokal destrüksiyon yapabilir, yüksek rekürrens riski taşır ve malignite ile ilişkilendirilebilir.

Juvenil nazofarengeal anjiofibrom

sfenopalatin foramen/pterigopalatin fossada merkezlenir ve kontrastta belirgin vasküler boyanır.

Sinonazal malignite

düzensiz kemik destrüksiyonu ve komşu yağ planlarına infiltrasyon polip için atipiktir.

Tuzaklar

• Yalnız koanadaki yumuşak dokuya bakıp maksiller sinüs kökenini kaçırma; polibin maksiller ostiumla bağlantısını koronal planda takip et.
• Retansiyon kisti geniş görünebilir ama sinüs ostiumundan nazal kaviteye uzanan devamlı gövdesi yoktur.
• BT'de antrokoanal polibin maksiller antrumu dolduran ve ostiumdan nazal kaviteye, posteriora koanaya uzanan yumuşak doku bileşenleri değerlendirilir.

Kendini dene

1. Tek taraflı maksiller sinüs lezyonu ostiumdan orta meatusa geçip koanaya uzanıyor; kemik duvar korunmuş. En olası tanı nedir?

   • Antrokoanal polip
   • Retansiyon kisti
   • İnverted papillom
   • Juvenil anjiofibrom
   Cevabı göster

   Antrokoanal polip. Maksiller antrumdan ostiuma ve koanaya devamlı uzanım antrokoanal polibin tipik yoludur; retansiyon kisti sinüs içinde kalır.

2. Maksiller sinüs tabanındaki kubbe biçimli lezyon ostiuma ulaşmıyor ve koana açık. En uygun alternatif hangisi?

   • Retansiyon kisti
   • Antrokoanal polip
   • Sinonazal SCC
   • Granülomatöz fungal kitle
   Cevabı göster

   Retansiyon kisti. Sinüs duvarından yükselen kubbe biçimli içerik ve koanaya uzanım olmaması retansiyon kistini destekler; polip ostiuma doğru devam eder.

Kaynaklar

Bu sayfadaki 32 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 8 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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