Frontal Sinus Pneumosinus Dilatans Combined with Excessive Aeration of All Paranasal Sinuses and Mastoid Air Cells

Objective: To report a case of a patient with chronic headache associated with pneumosinus dilatans of the frontal sinus, as well as excessive aeration of the rest of the paranasal sinuses and mastoid air cells. Patient: A 38-year-old female patient, who presented with chronic headache and symptoms resembling tension headache, was found by computed tomography imaging to have excessive aeration of the paranasal sinuses and the mastoid air cells. Especially the frontal sinus expanded superiorly, laterally, and posteriorly, significantly reducing the volume of the frontal lobe—a condition defined in literature as pneumosinus dilatans. The volumes and linear measurements of all air-filled cavities in the skull revealed values greater than the greatest reported in literature. The patient's symptoms were controlled by oral analgesics, and no surgical intervention was needed. Conclusions: To date, this is the first reported case of frontal sinus pneumosinus dilatans combined with excessive enlargement of all paranasal sinuses and the mastoid air cells. This condition is uncommon, and it might have been an incidental finding in this patient with headache. Treatment in similar cases, not complicated with paranasal sinus infection or pressure effects due to the expansion of the diseased sinuses, should be purely conservative.