III. Advantages

  1. Much more sensitive than Sinus XRay
  2. Good Sinus Anatomy definition
    1. Views sphenoid and Ethmoid Sinuses well
    2. Defines osteomeatal complex well

IV. Indications

  1. Sinusitis refractory to maximal medical management
    1. Recurrent Acute Sinusitis
    2. Persistent Chronic Sinusitis Symptoms
    3. Suspected Osteomeatal complex Occlusion
    4. Suspected Allergic Fungal Sinusitis
  2. Confusing presentation
  3. Evaluation before endoscopic surgery

V. Technique

  1. Full Coronal non-contrast Sinus CT
    1. Standard view indicated in most cases
  2. Limited Sinus CT
    1. Consider as alternative to full Sinus CT
    2. Four non-contiguous 5 mm slices in coronal plane
      1. Frontal Sinus
      2. Anterior ethmoid and Maxillary Sinuses
      3. Posterior ethmoid and Maxillary Sinuses
      4. Sphenoid Sinus
    3. Advantages
      1. Less expensive
      2. Less radiation
    4. Disadvantage
      1. Unknown efficacy
  3. Contrast Sinus CT
    1. Indicated in Periorbital Cellulitis or abscess

VI. Timing of scan

  1. Perform during maximal medical therapy
  2. Delay if URI present

VII. Relative Contraindications

  1. Submaximal medical Management
  2. Upper Respiratory Infection
  3. Acute sinus infection

VIII. Interpretation

  1. Findings consistent with Rhinosinusitis
    1. Air-fluid levels
    2. Total opacification
    3. Mucosal thickening >5 mm
  2. Complications identified by Sinus CT
    1. Osteomeatal Complex Obstruction
    2. Allergic Fungal Sinusitis

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