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This pictorial review summarizes CT “red flag” signs that should suggest underlying neoplastic disease and describes imaging features of common sinonasal 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Neoplasm: Raise the Red Flags!—A Pictorial Review  \nJyoti Kumar 1 Radhika Daga 1 Gaurav Pradhan 1 Ravi Meher2  \n1 Department of Radiodiagnosis, Maulana Azad Medical College & Associated Hospitals, New Delhi, Delhi, India  \n2 Department of Otorhinolaryngology Head and Neck Surgery, Maulana Azad Medical College & Associated Hospitals, New Delhi, Delhi, India  \nIndian J Radiol Imaging 2023;33:522–531.  \nAddress for correspondence Jyoti Kumar, MD, DNB, Department of Radiology, Maulana Azad Medical College and Lok Nayak Hospital, Jawaharlal Nehru Marg, New Delhi 110002, India  \n(e-mail: [drjyotikumar@gmail.com](drjyotikumar@gmail.com)).  \nAbstract  \nKeywords  \n► chronic sinusitis  \n► sinonasal neoplasms  \n► red flags  \n► CT  \nInflammatory pathology remains the most common indication for sinonasal imaging. However, sinonasal region is also the epicenter of a variety of neoplasms. These are often missed both clinically and radiologically owing to nonspecific signs and symptoms and subtle imaging pointers. An early diagnosis of sinonasal neoplasms is critical for timely management and hence better prognosis and survival rate.  \nThis pictorial review aims to acquaint the reader with the “red flag” signs on computed tomography that should raise suspicion for an underlying neoplastic pathology and also highlights the imaging features of common sinonasal neoplasms.  \nIntroduction  \nSinonasal imaging is primarily done using computed tomography (CT), the most common indication being chronic rhinosinusitis. Polypoidal sinonasal lesions are often a result of inflammatory pathology.  \nSinonasal cavity is also the epicenter of a diverse array of neoplasms that are often mistaken for inflammatory disease. As the early presenting symptoms may be nonspecific and imaging findings are often misinterpreted, presence of few clinical red flags may point toward an underlying serious pathology necessitating further workup in these cases. The clinical red flags include:  \n• Advancing age: Sinonasal neoplasms typically present after the age of 50 years. However, some sinonasal neoplasms are common in the pediatric age group that include rhabdomyosarcoma, esthesioneuroblastoma, nasopharyngeal carcinoma, and lymphoma.  \narticle published online May 6, 2023  \nDOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)10.1055/s-0043-1768612 . ISSN 0971-3026.  \n• Alarming clinical symptoms: While presence of rhinorrhea and nasal blockade is nonspecific findings,1 the presence of 4Ps that include Pain, Paraesthesia, Proptosis, Persistent nasal bleed may point to an underlying grave etiology.  \n• Clinical examination findings: Irregular, hard, ulceroproliferative lesion that is friable to touch and insensitive topain is red flag on direct nasal endoscopy. Additionally, presence of accompanying lymphadenopathy would point to an underlying sinister clinical disease.  \nAlthough sinonasal neoplasms constitute only approximately 3% of head and neck cancers, more than 50% of malignant neoplasms are diagnosed in an advanced stage with poor prognostic outcome.2 Awareness of the subtle pointers to an underlying neoplastic process on CT paranasal sinus along with a high index of suspicion is imperative for early diagnosis, which is the most important modifiable factor affecting survival.2  \n© 2023 . Indian Radiological Association. All rights reserved.  \nThis is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ([https://creativecommons.org/](https://creativecommons.org/)[ ](https://creativecommons.org/)[licenses/by-nc-nd/4.0/](licenses/by-nc-nd/4.0/))  \nThieme Medical and Scientific Publishers Pvt. Ltd. , A-12, 2nd Floor, S","cbCaief5Ucil77fS","https://ap.wps.com/l/cbCaief5Ucil77fS","pdf",9171050,"English","# Introduction\n## Clinical red flags\n## CT “red flag” signs\n## Unilateral sinonasal disease/single sinus disease","[{\"question\":\"Why can sinonasal neoplasms be missed in imaging and clinically?\",\"answer\":\"They often present with nonspecific symptoms and subtle imaging pointers that resemble inflammatory conditions, leading to delayed suspicion.\"},{\"question\":\"What clinical signs may raise suspicion for an underlying neoplastic cause?\",\"answer\":\"Advancing age, alarming symptoms, and concerning examination findings such as an irregular hard ulceroproliferative friable lesion, with possible lymphadenopathy, are highlighted.\"},{\"question\":\"Which CT findings are considered “red flag” signs for neoplastic pathology?\",\"answer\":\"The review lists CT red flags including unilateral disease, olfactory recess involvement, mild hyperdensity with solid/heterogeneous enhancement, focal hyperostosis, osseous destruction or remodeling, extrasinus extension, perineural spread, and lymphadenopathy.\"}]","Sinonasal Inflammation or Neoplasm - Raise the Red Flags! - A Pictorial Review | PDF",1790564108,25]