Skip to main content

Emergency radiologic approach to sinus disease

Abstract

Sinus disease is commonly encountered, especially in the acute care setting. Imaging can support a diagnosis of sinusitis, help identify an etiology, and delineate intracranial and extracranial complications. Suspicion of complicated rhinosinusitis is an indication for contrast-enhanced computed tomography or magnetic resonance imaging. It is important for radiologists to be familiar with patient risk factors that predispose to uncommon but aggressive forms of sinus disease such as invasive fungal sinusitis. Lastly, many conditions, ranging from benign to malignant, can mimic rhinosinusitis clinically and on imaging. Radiologists can help by recognizing these entities and facilitating appropriate referral and follow-up. This article reviews the breadth of sinus disease commonly encountered in the emergency setting, potential complications, and mimics.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Data availability

Not applicable.

Code availability

Not applicable.

References

  1. Ho YW, Govindaraj S (2015) Sinusitis. In: Sampson HA (ed) Allergy and clinical immunology, 1st edn. Wiley, New Jersey, pp 52–65

    Chapter  Google Scholar 

  2. Wyler B, Mallon WK (2019) Sinusitis update. Emerg Med Clin N Am 37:41–54. https://doi.org/10.1016/j.emc.2018.09.007

    Article  Google Scholar 

  3. Orlandi RR, Kingdom TT, Hwang PH et al (2016) International Consensus Statement on Allergy and Rhinology: rhinosinusitis. Int Forum Allergy Rhinol 6:S22–S209

    PubMed  Google Scholar 

  4. Rosenfeld RM (2016) Acute sinusitis in adults. N Engl J Med 375:962–970. https://doi.org/10.1056/nejmcp1601749

    Article  PubMed  Google Scholar 

  5. Kuek LE, Lee RJ (2020) First contact: the role of respiratory cilia in host-pathogen interactions in the airways. Am J Physiol Lung Cell Mol Physiol 319:L603–L619. https://doi.org/10.1152/ajplung.00283.2020

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. Meltzer EO, Hamilos DL, Hadley JA et al (2004) Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol 114:115–212. https://doi.org/10.1016/j.jaci.2004.09.029

    Article  Google Scholar 

  7. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS et al (2015) Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg 152:S1–S39. https://doi.org/10.1177/0194599815572097

    Article  PubMed  Google Scholar 

  8. Chandler JR, Langenbrunner DJ, Stevens ER (1970) The pathogenesis of orbital complications in acute sinusitis. Laryngoscope 80:1414–1428. https://doi.org/10.1288/00005537-197009000-00007

    CAS  Article  PubMed  Google Scholar 

  9. Koltsidopoulos P, Papageorgiou E, Skoulakis C (2020) Pott’s puffy tumor in children: a review of the literature. Laryngoscope 130:225–231. https://doi.org/10.1002/lary.27757

    Article  PubMed  Google Scholar 

  10. Momeni AK, Robers CC, Chew FS (2007) Imaging of chronic and exotic sinonasal disease: review. Am J Roentgenol 189:S35-45. https://doi.org/10.2214/ajr.07.7031

    Article  Google Scholar 

  11. Tan BK, Kern RC, Schleimer RP, Schwartz BS (2013) Chronic rhinosinusitis: the unrecognized epidemic. Am J Respir Crit Care Med 188:1275–1277. https://doi.org/10.1164/rccm.201308-1500ed

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sonkens JW, Harnsberger HR, Blanch GM, Babbel RW, Hunt S (1991) The impact of screening sinus CT on the planning of functional endoscopic sinus surgery. Otolaryngol Head Neck Surg 105:802–813. https://doi.org/10.1177/019459989110500606

    CAS  Article  PubMed  Google Scholar 

  13. DelGaudio JM, Loftus PA, Hamizan AW, Harvey RJ, Wise SK (2017) Central compartment atopic disease. Am J Rhinol Allergy 31:228–234. https://doi.org/10.2500/ajra.2017.31.4443

    Article  PubMed  Google Scholar 

  14. Marcus S, Schertzer J, Roland LT, Wise SK, Levy JM, DelGaudio JM (2020) Central compartment atopic disease: prevalence of allergy and asthma compared with other subtypes of chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 10:183–189. https://doi.org/10.1002/alr.22454

    Article  PubMed  Google Scholar 

  15. Aribandi M, McCoy VA, Bazan C (2007) Imaging features of invasive and noninvasive fungal sinusitis: a review. Radiographics 27:1283–1296. https://doi.org/10.1148/rg.275065189

    Article  PubMed  Google Scholar 

  16. Smith SM, Thelen JC, Bhatt AA, Kessler AT (2021) Facial swelling for the emergency radiologist-typical and atypical causes. Emerg Radiol 28:177–183. https://doi.org/10.1007/s10140-020-01809-x

    Article  PubMed  Google Scholar 

  17. Lloyd KM, DelGaudio JM, Hudgins PA (2008) Imaging of skull base cerebrospinal fluid leaks in adults. Radiology 248:725–736. https://doi.org/10.1148/radiol.2483070362

    Article  PubMed  Google Scholar 

  18. Eggesbø HB (2012) Imaging of sinonasal tumours. Cancer Imaging 7:136–152. https://doi.org/10.1102/1470-7330.2012.0015

    Article  Google Scholar 

  19. Sen S, Chandra A, Mukhopadhyay S, Ghosh P (2015) Imaging approach to sinonasal neoplasms. Neuroimaging Clin N Am 25:577–593. https://doi.org/10.1016/j.nic.2015.07.005

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alok A. Bhatt.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

McCann, M.R., Kessler, A.T. & Bhatt, A.A. Emergency radiologic approach to sinus disease. Emerg Radiol 28, 1003–1010 (2021). https://doi.org/10.1007/s10140-021-01945-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-021-01945-y

Keywords

  • Sinus disease
  • Acute sinusitis
  • Chronic sinusitis
  • Atopic disease
  • Invasive fungal sinusitis