Breast MRI-the Importance of Type II and III Dynamic Curves Evaluation and Framing in BI-RADS 4C and 5 Score.

BACKGROUND: Breast Magnetic Resonance Imaging (MRI) offers the highest sensitivity in detecting breast cancer among existing clinical and imaging techniques, making it a crucial component of breast imaging protocols. This study aims to investigate MRI importance in correlation with previous imaging discordant procedures performed as echography and/or mammography to evaluate characteristics and framing in high-risk BI-RADS 4C or 5 categories based on morphological features and kinetic curves of masses found in the breasts of patients from our database. METHODS: A retrospective study with related statistical analysis was performed on a group of 33 cases, selected from a total of 488 patients who underwent breast MRI examinations at SPAD Imaging International S.R.L. Craiova, between 01.01.2021 and 31.12.2023, aged between 33 and 75 years. In all patients, MRI images parameters were analysed. RESULTS: In 33 patients, 23 had a single lesion and 10 had multiple lesions, 9 of them in the ipsilateral breast and, as a particularity, one of them, located in the contralateral breast. In 21 of the total patients with multiple or single lesions they had type III curves, which were classified in the BI-RADS 5 category, considering both criteria-morphology and type of curve, where the other previous techniques had not mentioned an increased risk, hence revealing that the situation in a percentage of 63.63 in the case of MRI investigation proved to be clearly superior. CONCLUSION: Combining both kinetic and morphologic criteria can enhance the diagnostic accuracy of MRI in breast lesion evaluation.

Indication and Timing of Cholecystectomy in Acute Biliary Pancreatitis - Systematic Review.

Acute biliary pancreatitis (ABP) poses significant challenges in determining the optimal timing and approach for cholecystectomy, particularly in mild, moderately severe, and severe forms. This article reviews the existing literature on cholecystectomy timing and its impact on outcomes in ABP. A systematic literature search yielded 41 relevant articles from PubMed and Scopus databases. In mild ABP, early cholecystectomy within 72 hours of onset is increasingly favoured due to reduced technical difficulty and lower risk of recurrent pancreatitis. Conversely, delayed cholecystectomy, although traditionally practiced, may lead to higher recurrence rates and prolonged hospital stays. For moderate severe ABP, evidence remains limited, but early cholecystectomy appears to decrease hospital stay without increasing perioperative complications. In severe ABP, consensus suggests delaying cholecystectomy until peripancreatic collections resolve, typically 6 to 10 weeks post-onset, to minimize surgical morbidity. The role of endoscopic retrograde cholangiopancreatography (ERCP) alongside cholecystectomy remains contentious, with guidelines recommending its use in specific scenarios such as cholangitis or biliary obstruction. However, routine ERCP in mild ABP lacks robust evidence and may increase complications. Challenges persist regarding the management of residual choledocholithiasis post-ABP, highlighting the need for improved diagnostic criteria and management protocols. Overall, this review underscores the evolving landscape of cholecystectomy timing in ABP and provides insights into current best practices and areas for future research.

Imaging Aspects of Enchondromas in Pediatric Patients.

Enchondromas are benign tumors located primarily in long bones, some of which can be accidentally discovered during imaging exams conducted for other pathologies. These benign cartilaginous tumors are hard to differentiate from low grade chondrosarcomas, which require periodic follow ups. The purpose of this study was to identify the incidence of enchondromas in pediatric patients, to determine medical imaging criteria (Computed Tomography-CT and Magnetic Resonance Imaging-MRI) in order to differentiate enchondromas from other atypical cartilaginous tumors, and to identify a potential correlation between imaging aspects and clinical signs. The aim of this study was to review imaging findings of enchondromas in children.

Cabergoline Failure and a Spontaneous Pregnancy in a Microprolactinoma with High Prolactin Levels.

We report a particular case of a spontaneously occurring pregnancy in a long-term amenorrheic patient due to a prolactinoma with high serum prolactin (PRL) following the failure of dopamine agonist therapy (DA) for infertility. Initially, clinical, laboratory, and genital ultrasounds were normal, but the serum PRL was 10,074 µIU/mL (n.v.: 127−637 µIU/mL), the PEG fraction was 71% (laboratory cut-off > 60%), and luteinizing hormone (LH) was significantly lower. An MRI revealed a pituitary tumor of 12.8/10 mm with a subacute intratumoral hemorrhage. DA was initiated, and menstrual bleeding reappeared with a reduction in the tumor's volume to 1.9/2.2 mm at 12 months. Two years later, the patient renounced DA and follow-ups. After another 2 years, she became spontaneously pregnant. Serum PRL was 18,325 µIU/mL, and an MRI revealed a microprolactinoma of 2.1/2 mm. The patient gave birth to a normal baby at term, and she breastfed for six months, after which she asked for ablactation, and DA was administered. This case highlights the possibility of the occurrence of a normal pregnancy during a long period of amenorrhea induced by a microprolactinoma with a high level of serum PRL, even if DA fails to correct infertility. There was no compulsory relationship between the tumoral volume's evolution and the evolution of its lactophore activity. The hypogonadotrophic hypogonadism induced by high PRL was mainly manifested by low LH, and in this situation, normal levels of FSH and estradiol do not always induce follicle recruitment and development without abnormalities in the ovary ultrasound.

Immunohistochemical evaluation of D2-40, Galectin-3, Maspin and MCM7 expression in palate squamous cell carcinomas.

Squamous cell carcinoma (SCC) is the most frequent cancer in oral cavity and its prognosis has exhibited little improvement in the last decades. Although much less common palate SCCs manifests a higher local aggression invading very quickly the adjacent muscles and jawbones, thus being able frequently to lead to dysfunctions in chewing, swallowing, and speech. To elucidate what underlies such local aggression, we investigated the immunohistochemical expression in palate SCCs of Podoplanin (D2-40), Galectin-3 (Gal-3), mammary serine protease inhibitor (Maspin) and minichromosome maintenance complex component 7 (MCM7), markers that are known to be involved in tumor invasiveness. We found a progressive increase in reactivity for D2-40 and MCM7 from the normal epithelium toward dysplastic epithelium and respectively to SCC, which suggests the intervention of these markers in the early stages of squamous cell carcinogenesis in the palate. The highest D2-40, Gal-3 and MCM7 reactivity was observed in basaloid and in poorly differentiated (G3) palate SCCs, while for Maspin the well-differentiated (G1) palate SCCs were the most reactive. The first three markers mentioned above were most intensely expressed at the invasion front, while the Maspin reactivity was low or absent at this level. Statistically, we found significant stratification on localization, grading, muscle invasion, and survival for all investigated markers, but with very high direct correlations between D2-40, Gal-3, and MCM7 immunoreactive score (IRS) values, while between the Maspin and each of the previous markers there were very high inverse correlations. Overall, all these investigate markers proved to be responsible for the local invasiveness and regional lymph node metastasis, thus allowing a prognostic and therapeutic stratification of patients with palate SCCs.

Histopathological aspects of benign mesenchymal tumors located in "high risk areas" of the tongue.

Although a series of premalignant or potentially malignant lesions are described in the tongue, there are many other lesions whose potential of degeneration can be determined by a prolonged action of irritant or carcinogenic factors. Even if they are practically considered to be harmless, benign formations of mesenchymal origin with lingual location represent in the same time a neoplastic lesion under the influence of local and general factors, for a variable period of time. When these structures are located in major risk areas from the oral cavity and in particular, those directly related to the tongue, special attention should be paid to their development. In this study (conducted on a total of 16 cases of benign mesenchymal malignancies), we planned a histopathological evaluation of surgical excision samples obtained from interventions on lingual neoplasias, and harvested from areas with the highest risk for lingual cancer development (pelvilingual groove, the base of the tongue and the insertion of the anterior pillar) in order to assess the histopathological aspects in different types of lesions and the possible presence of degenerative changes.

Three-Dimensional Model of the Human Eye Development based on Computer Tomograph Images.

The objective of this study was to obtain a virtual biomechanical three dimensional model of the human eye though a multidisciplinary collaboration between researchers in various medical and informational fields in order to reach a better understanding of the optical performance of the healthy and diseased eye. MATERIAL AND METHOD: In order to obtain the virtual model, we analyzed the CT and MRI images of six patients, aged between 21 and 80 years old, dating from February 2013 until January 2019. These scans totalized 4226 images. We selected to use for the construction of the model the CT images of a male patient of 54 years old. In Vesalius and Geomagic for SolidWorks programs were used. RESULTS: Based on the CT images analysis and using the above mentioned programs, we created a virtual model of the human skull in which the orbit is located, including the eye globe and the extraocular muscles. The SolidWorks virtual model allows the attachment of materials with real properties of the eye tissues. This model can be used in various simulations for the healthy and diseased eye. CONCLUSIONS: The biomechanical eye model of the eye was created based on a "in vivo" eye model. As the SolidWorks format enables using materials with identical properties to those of the human eyeball, this virtual model can provide very realistic eye simulations.

Multidisciplinary approach to patients with manifestations and pulmonary complications of cystic fibrosis.

Cystic fibrosis (CF) is a genetic disease, with autosomal recessive transmission, multisystemic, characterized by a remarkable clinical polymorphism and significant lethal prospective. Respiratory manifestations dominate the clinical picture, being present in all patients. The aim of the paper was to analyze the incidence of clinical manifestations, especially respiratory ones, as well as the contribution of interdisciplinary consultations to the positive diagnosis of CF, in a group of 16 patients who were hospitalized and treated in the IInd Pediatric Clinic and IInd Medical Clinic of the Emergency County Hospital, Craiova, Romania, in a period of 20 years. The 16 patients diagnosed with and treated of CF had all shown increased values of sweat chloride concentration of over 60 mmol∕L. The main symptoms and clinical signs encountered in these patients were cough (75%), sputum (62.5%), dyspnea (50%), wheezing (50%), stature hypotrophy (100%), pallor (37.5%), cyanosis (25%). All 16 patients had an acute exacerbation of chronic pulmonary disease. Of the total hospitalizations, the death was recorded only in the case of one female patient. The association of some clinical aspects specific with a positive result of the sweat test or the presence of the two pathological alleles made room for determining a positive diagnosis. The multisystemic nature of this disease requires a multidisciplinary approach to these patients. Histopathologically, there was a correspondence between lung morphological lesions and the results of imaging investigations.

Tuberous sclerosis complex: report of two intrafamilial cases, both in mother and daughter.

Tuberous sclerosis complex (TSC) is a multisystem syndrome characterized by neurological symptoms and tumors in multiple organs including kidney, brain, skin, eyes, heart and lung. Kidney and brain are the two most frequently affected organs in TSC. TSC is an autosomal disorder with extensive clinical variability. We described TSC in a family at a mother and her daughter. We emphasized the importance of Computed Tomography in the discovery of some asymptomatic organic involvement as bilateral renal angiolipoma in the mother.

Subungual exostosis of the big toe.

The subungual exostosis is a benign bone tumor on the distal phalanx of a digit, beneath or adjacent to the nail, often bringing in discussion many differential diagnosis. We present a 14-year-old boy with a cutaneous nodular lesion, painful to the easy touch on the latero-internal half of the nail of right big toe with extension in the cutaneous part of this. He suffered many treatments, especially cauterization, but with recurrence. In the present, the radiological findings of the affected finger and the histopathological ones from the fragment excised confirmed the diagnosis of subungual exostosis. The local excision of the entire region with the removal of the cartilaginous cap has been followed by a silent period without recurrences of almost two years when he as revised.

Management of second branchial cleft anomalies.

Branchial cleft anomalies are developmental disorders of the neck. The aim of this study was to evaluate the data of our patients, who have been diagnosed and treated for second branchial abnormalities in the last six years. We report our clinical experience in second branchial anomalies with a review of the literature. Our study is a retrospective one on a number of 23 patients hospitalized within 2001-2007 in ENT Clinic of Craiova for second branchial abnormalities in relation with age, gender, origin environment, clinical and paraclinical context in which the therapeutic decision was made, surgical procedures, post-surgical evolution. Among the anomalies of the second branchial arch, we encountered 10 (43.47%) patients with branchial cyst and 13 (56.52%) patients with branchial sinus. Twelve (52.17%) of the 23 patients were women and 11 (47.83%) were men; 9 (39.13%) patients were diagnosed and treated within the first age decade, seven (30.43%) within the second age decade, five (39.13%) within the third age decade and two (8.71%) in the fourth age decade. Histological examination of the lesions after excision established the diagnosis in all the cases. Second branchial arches anomalies are the most common branchial anomalies. Sinuses are more frequently than cysts and branchial fistulae are extremely rare. There is no gender predilection. The majority of patients (approximately 70%) were diagnosed and treated during their childhood. Treatment for these lesions is complete surgical excision for prevent recurrences.

Portal cavernomatous transformation leading to variceal hemorrhage in Sturge-Webber syndrome. A rare, but possible association.

UNLABELLED: Sturge-Weber syndrome is a rare disorder consisting of a port-wine nevus in the distribution of the ophthalmic branch of the trigeminal nerve and central nervous system malformations. Facial cutaneous vascular malformation, seizures, and glaucoma are among the most common symptoms and signs. The syndrome results from malformation of the cerebral vasculature located within the pia mater, most commonly over the occipital region. These malformations led to venous hypertension and subsequent hypoperfusion on the underlying cortex, causing chronic cerebral ischemia, atrophy, calcification and neurological deterioration. We describe 18-years-old young girl hospitalized for upper digestive hemorrhage that revealed a cavernomatous transformation of portal vein. At the same time, she presents extensive congenital, bilateral port wine stains on the face, epilepsy and glaucoma of the right eye. Computer tomography showed intracranial vascular abnormalities with calcifications, particularly in the right occipital lobe. The clinical presentation and imagistic assessment confirmed the diagnosis of Sturge-Weber syndrome associated with upper non-cirrhotic portal hypertension generated by a malformation of portal vein. CONCLUSIONS: Upper digestive hemorrhage is a quite rare eventuality in the Sturge-Webber syndrome. Moreover, portal tract malformations with cavernomatous transformation are exceptionally cited in the literature. Despite this rare association, abdominal investigation, as well as computed cranial tomography should be performed in all cases of children that present a facial cutaneous vascular malformation.

Bone abnormalities occurring in the follow-up of the patients with neurofibromatosis type 1.

Neurofibromatosis type 1 (NF1), also called von Recklinghausen disease or peripheral neurofibromatosis, is a common autosomal dominant disorder characterized by multiple neurofibromas, "café au lait" spots and Lisch nodules of the iris with a variable clinical expression. Osseous anomalies appeared in the patients with NF1 including dysplasia, scoliosis and pseudoarthrosis. We propose a research of the osseous involvement at 11 patients, seven female and four male with ages from 9 to 60 at which the cutaneous aspect has the complete form, hyperpigmented spots and cutaneous neurofibromas and only more than six "café au lait" spots. All the patients suffered radiological exams, CT- and MRI-scan. The results were different from case to case from the extreme severe deformations, especially at the children, to clinical unapparent osseous involvement, incidental found or with occasion of our investigation. CONCLUSIONS. The patients with NF1 has osseous abnormalities specific of the disease, like dysplasia, scoliosis, pseudoarthrosis, often gentle but sometimes extremely severe. The most severe osseous involvement are presented in the cases when these development early in the childhood. Other times the osseous abnormalities are clinical asymptomatic, their finding been clinical incidental. We want to have a separate mention for the maxillary and mandible involvement, which according to our information is not a rare form.

Intramuscular human Dirofilaria repens infection of the temporal region - case report and review of the literature.

Dirofilariasis is a zoonotic worldwide-distributed disease, especially in regions with warm to temperate climate, where it recently recorded a significant increase of prevalence. A 61-year-old female, a dog owner, residing in the Southwest of Romania, near a swamp, developed a painless nodule in the left temporal region. The contrast-enhanced computed tomography (CT) scan revealed a temporal intramuscular cystic lesion. The surgical exploration confirmed the lesion as with intramuscular localization. The histopathology and biochemistry investigations established as a cause of the lesion an infestation with Dirofilaria repens species. The patient underwent an anthelmintic treatment with Diethylcarbamazine and the clinical and radiological follow-up did not revealed any recurrences within a period of 15 months after surgery. This is the second case reported in Craiova (Romania), the seventh worldwide reported case with localization in the temporal region, and the second one with intramuscular development in this region. The existence of such cases should alert the clinician to include parasitosis in the differential diagnosis of atypical space-occupying lesions of the head regions.

Which is the Best Imaging Method in Pancreatic Adenocarcinoma Diagnosis and Staging - CT, MRI or EUS?

INTRODUCTION: Imaging has a decisive role in the diagnosis and staging of pancreatic cancer, the most used imaging methods being computed tomography, magnetic resonance imaging and endoscopic ultrasonography. MATERIAL AND METHOD: They were studied retrospectively over a 3 years period, 140 patients with pancreatic cancer. AIM OF THE STUDY: This study aims to determine the effectiveness of CT, MRI and EUS in diagnosis and staging of panceatic cancer. RESULTS: CT showed a diagnostic accuracy of 83.3%, with sensitivity and specificity of 81.4% and 43% respectively. MRI showed superior diagnostic accuracy compared to CT (89,1%). However, EUS demonstrated the best diagnostic value in PC (accuracy of 92,7%). Concerning the locoregional staging, the 3 diagnostic methods showed similar result. There were no significant differences concerning the diagnosis of intra-abdominal metastases. Differences have appeared in the case of extra-abdominal. Thus, there were 4 cases of lung metastases which have been identified only on CT and MRI. CONCLUSION: EUS is the most effective technique used in the diagnosis of pancreatic cancer, the present study demonstrating an accuracy of 92.7%. Moreover, EUS offers the possibility to collect samples for cytological examination by EUS guided fine needle aspiration. However, there are some limitations of EUS in identifying extra-abdominal metastases. Thus, the assessment of tumor extension must be completing by performing CT or MRI.

[The pancreatic pseudocyst--late complication of the severe acute pancreatitis. Therapeutic options]. / Pseudochistul de pancreas, complicatie tardiva a pancreatitelor acute severe. Posibilitati si optiuni terapeutice.

AIM: the assessment of the therapeutical methods in the pancreatic pseudocyst occurred after severe acute pancreatitis. MATERIAL AND METHOD: 30 (33.3%) pancreatic pseudocysts (18 men and 12 women aged between 28-64) occurred in the evolution of 90 severe acute pancreatitis in the last 5 years (2000-2004) were analyzed. The diagnosis was established on the clinical and imaging aspects on average 1 month after the onset of the severe acute pancreatitis. The treatment was different, depending on size, anatomo-clinical form, pseudocyst age, presence of complications and the biological status of the patient. 14 uncomplicated pseudocysts, with the diameter less than 6 cm, were treated conservatively, until their complete resorption. 6 cases were operated on (2 cysto-gastrostomy, 1 cysto-jejunostomy and 3 external drainage). We performed percutaneous external CT guided drainage in 2 cases and endoscopic drainage in other 8 cases (trans-papillary-trans-ductal drainage 3 cases and endoscopic US guided drainage in 5 cases: transgastric 2, transduodenal 2 and transesophageal 1). RESULTS: 28 (93.3%) cases had a fair evolution (complete resorption in 14 uncomplicated pseudocysts after 3-6 weeks of conservative treatment). We registered 2 gastro-duodenal bleeding during endoscopic US guided drainage, which required operation (haemostasis cysto-gastrostomy). Mortality rate was 0. CONCLUSIONS: 1. The pseudocyst is the main late complication of the severe acute pancreatitis (33.3% in our study). 2. The uncomplicated pseudocysts with the diameter less than 6 cm, benefit of the conservative treatment and monitoring in progress until their complete resolution. 3. There are 3 therapeutical methods for the pseudocysts more than 6 cm in diameter and/or complicated: the percutaneous external US/CT guided drainage, the endoscopic drainage and surgery. 4. The option for the drainage procedure must take into account the morphological and evolutionary aspects of the pseudocyst, the age and biological status of the patient.

Clinico-imaging and anatomopathologic correlations in sarcomas of maxilla.

Sarcomas are relatively uncommon tumors, accounting for 1% of all malignancies. Sarcomas are commonly classified according to their site of origin: soft tissues or bone. The purpose of the clinic study was to focus the symptoms and the clinic signs. The radio-imaging study is essential in the evaluation of the maxilla tumors. The histopathologic study was done to determine the histological type, the differentiation level, the invasion level as well as the presence or absence of the metastases in drainage ganglia. The correlation of the findings of this study leads to a clear and correct clinic diagnosis, an adequate local or general therapy and a prognostic. The diagnostic role of imaging is essential and often permits the orientation to benignity or, on the contrary, requires biopsy if the image is an aggressive one or of uncertain nature. Advances in diagnostic imaging have contributed substantially to the management of tumors. The strong collaboration among the physician, imaging personnel and anatomo-pathologist serves the patient's benefit.

Pancreatic pseudoaneurysm of the superior mesenteric artery complicated with obstructive jaundice. A case report.

CONTEXT: Pancreatic pseudoaneurysm rupture is a rare complication of chronic pancreatitis, with severe prognosis and high mortality. Angiography is usually required for confirmation of the diagnosis, but transabdominal ultrasound and CT angiography are useful noninvasive diagnostic methods. CASE REPORT: We present the case of a 66-year-old patient with a large pancreatic pseudoaneurysm of the superior mesenteric artery complicated with obstructive jaundice. Transabdominal ultrasound with color and power Doppler showed a large pancreatic head pseudoaneurysm that communicated directly to the superior mesenteric artery. Presence of a spinning blood flow inside the pseudoaneurysm was visualized by color Doppler, with evidence of bidirectional flow in the pseudoaneurysm neck that was showed by Doppler spectral analysis. The contrast-enhanced helical computer tomography with multiplanar sagittal and the 3D reconstruction of coronal images confirmed the communication of the pseudoaneurysm with the superior mesenteric artery. The patient was scheduled for selective angiography and embolization. However, clinical evolution was rapidly deteriorating, with collapse, hemorrhagic shock and massive hemorrhage. The patient was operated on and subsequently died despite three days of intensive care, due to disseminated intravascular coagulation and multiorgan failure. CONCLUSION: Non invasive imaging methods consisting of transabdominal ultrasound with color Doppler and contrast-enhanced computer tomography with sagittal reconstruction of coronal images were very useful in the establishment of the diagnosis of pancreatic pseudoaneurysm of the superior mesenteric artery complicated with cholestatic jaundice. However, these imaging methods do not obviate the need for diagnostic and therapeutic angiography, eventually followed by surgical intervention in cases of recurrent bleeding or hemodynamic unstable patients.

[Severe acute pancreatitis--diagnostic and therapeutic strategy]. / Pancretitele acute severe--strategie diagnostica si terapeutica.

To establish the optimal diagnosis and therapeutical strategy in severe acute pancreatitis. 94 (56.9%) severe acute pancreatitis (79 males and 15 females, aged between 26 and 81), selected from 165 acute pancreatitis admitted in the last 5 years (2000-2004) were analyzed. The disease was assigned as severe when one or more of the following criteria were present: Ranson score >3 on admission or at 48 hours, APACHE II score >8, visceral failures, Balthazar CT score C, D or E and local complications (infected necrosis, pseudocyst or pancreatic abscess). Medical treatment (aggressive supportive intensive care therapy, minimizing pancreatic secretion and antibiotic therapy) was the first therapeutical step in all cases. 49 (52.1%) patients were operated on: 20 as early surgery imposed by biliary sepsis (16 cases) or by an acute abdomen with uncertain etiology and unfavourable evolution, and 22 as late surgery (at least 12 days after onset), imposed by the presence of the infected pancreatic necrosis, visceral failures or other local complications, the necrosectomy being the main surgical procedure for infected necrosis. 77 (81.9%) cases had a fair evolution. The conservative treatment led to a complete recovery in 37 (37.2%) cases. We registered an overall mortality rate of 12.7% and postoperative mortality rate of 14%; we also registered 5 (10.2%) postoperative complications: 4 pancreatic and 1 colonic fistulae. (1) The treatment of the severe acute pancreatitis must be performed only in the specialized multidisciplinary well equipped centers with very well trained staff. (2) Medical conservative treatment (aggressive supportive intensive care therapy and antibiotic therapy) is the main therapeutical method within the acute phase (first two weeks). (3) Very restrictive surgical indications within the acute phase. (4) Necrosectomy is the main surgical procedure for the infected necrosis.

Silent sinus syndrome--report of a case.

INTRODUCTION: The "silent sinus syndrome" is a rare entity that was first described in 1964 and given this name 30 years later. Although it is well described both from clinically and radiologically point of view we consider that its rarity still makes it a subject for report. CASE PRESENTATION: A 46-year-old patient was admitted for facial asymmetry, diplopia, unilateral left enophthalmos, and inferior displacement of the eye globe, and decreased occlusal pressure in left dentate region. CT scan revealed interior bulging of all left maxillary sinus walls with osteolysis and intense opacification, enlargement of the left middle meatus especially in the posterior part and lateralization of the uncinate process. Nasal endoscopy with 00 rigid scope visualized mild deviation to the right of the nasal septum, enlargement of the left middle meatus by the lateral deviation of the left intersinusal septum and uncinate process. Surgery was scheduled and performed a left maxillary sinus antrostomy. Histopathological examination on the biopsies revealed inflammation. A complete study was performed to assess the elements of inflammation. Postoperative course was simple. Follow-up visit at three and six months, showed significant regression of diplopia and improved facial aspect. CONCLUSIONS: Silent sinus syndrome is a well-defined clinical entity with characteristic imagistic findings. Surgical intervention that restores sinus drainage will interrupt the pathogenesis of the disease and lead to its progressive regression. Topographic associations and density of inflammatory elements analyzed in relation with neoforming vessels suggest their implication in reparatory angiogenesis characteristic to chronic inflammation. Modulating activity in the frame of inflammatory process, of the T-lymphocytes and especially of T-lymphocytes may represent a target for the therapeutic management. Surgery can and should be performed by an endoscopic approach.