Transcript The Role of Imaging in Sinusitis

The Role of Imaging in
Sinusitis
Dr Mohamed El Safwany, MD.
Intended learning outcome
• The student should learn at the end of this
lecture role of imaging in sinusitis.
Pediatric Population
• The nasal sinuses are not
developed at birth
• The maxillary and ethmoid sinuses begin to
develop first and the frontal sinuses are the
last to appear between 5-7 yrs of age
• They become progressively aerated and may
not be completely developed until up to 10
yrs of age
• A normal radiograph in a young child can be
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confused with sinusitis or other sinus disease
due to opacification
This sometimes occurs when radiographs are
ordered for other reasons such as trauma
Therefore, routine sinus radiographs are not
very useful in young children to make the
diagnosis of sinusitis
Older Children and Adults
• In general, sinusitis is a clinical diagnosis
and imaging should be reserved for cases
that are unresponsive to treatment, when
complications are suspected, or when the
diagnosis is questionable
• The typical imaging used for detecting
sinus disease are plain films and axial and
coronal CT scans
Plain Films
• The typical sinus series consists of 4 views
• The Water’s view can be useful in detecting
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maxillary sinusitis
Caldwell’s view is used to evaluate the frontal
sinus
The submentovertex view looks at the sphenoid
sinus and also the anterior and posterior walls of
the frontal sinus
The lateral view shows the frontal, maxillary,
and sphenoid sinuses
• Plain films are not very specific for
sinusitis because opacity can be difficult to
distinguish from other pathology such as
tumors
• Signs on a plain film that suggest sinusitis
include opacification, air-fluid level, or
6mm or more of mucosal thickening
CT Scan
• CT scan is considered the gold standard for sinus
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imaging and the coronal view is typically the image of
choice. Axial views are needed to complement the
coronal views when severe disease is suspected in the
ethmoid and sphenoid sinuses.
Signs suggestive of sinusitis on CT include opacification,
air-fluid level, sinus wall displacement, and/or mucosal
thickening of 4mm or more
Since CT scans can show much more anatomical detail
of the sinuses, they are especially useful when clinicians
are concerned about complications or extension of
disease from sinusitis
• CT scans are often used to evaluate a patient
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before surgical intervention for chronic sinus
disease
Surgeons use it mainly to document the
presence of disease and to look for any
anatomical abnormalities that could increase the
risk of complications during surgery
For surgical evaluation, the CT scan should be
obtained after treatment with broad spectrum
antibiotics and at least 4 weeks of topical nasal
steroids otherwise it is difficult to assess the
meaning of a positive scan
Text Book
• David Sutton’s Radiology
• Clark’s Radiographic positioning and
techniques
Assignment
• Two students will be selected for
assignment.
Question
• Define role of CT in sinusitis?
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Thank You