16 Imaging Evaluation of Sinusitis: Impact on Health Outcome

Chapter

Key Points

The clinical signs and symptoms of acute bacterial sinusitis (ABS) overlap with that of nonspecific upper respiratory track viral infection (strong evidence). Children under the age of 6 years should not undergo sinus radiographs due to their limited sinus development (moderate evidence). Sinus radiographs are moderately sensitive to diagnose ABS compared with sinus puncture and culture (moderate evidence). Although a CT scan is frequently performed to assist diagnosis of sinusitis, no adequate data exists on the sensitivity and specificity of sinus CT for diagnosis of ABS (limited evidence). Definitive imaging criteria are presence of frothy air-fluid levels or complete sinus opacification, but do not include mucosal thickening (limited evidence). Despite relatively high sensitivity of CT or sinus radiography, ­imaging is not indicated in the initial diagnostic work up for acute uncomplicated sinusitis, due to cost and radiation dose (strong evidence). Imaging study is indicated for patients who fail to respond to medical management, or severe symptoms suspicious for complications related to acute sinusitis, or patients planning to undergo surgery (moderate evidence). The diagnosis of chronic sinusitis is based on clinical grounds. No gold standard exists to confirm clinical diagnosis. CT findings for chronic sinusitis often do not correlate with patients’ clinical symptoms (limited evidence). Imaging (contrast enhanced CT or MR) is indicated in immunocompromised patients with acute progression of sinus infection with neurological symptoms in order to assess potential complications from acute sinusitis.

Keywords

Placebo Transportation Migraine Neutropenia Meningitis 

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Copyright information

© Springer New York 2011

Authors and Affiliations

  1. 1.Department of RadiologyUniversity of WashingtonSeattleUSA

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