II. Indications
- In adults, Sinus CT is far preferred over XRay if sinus imaging is needed
- Consider Sinus XRay in children (or in under-resourced regions)
- Evaluation of Suspected Chronic Sinusitis
- Evaluation of Acute Sinusitis:
- Persistent symptoms despite adequate treatment
- High risk patients
- Suspected involvement in multiple Paranasal Sinuses
III. Contraindications (Relative)
- Ethmoid or Sphenoid Sinusitis
- Age under 3 years
- Undeveloped sinuses
- High False Positive opacification rate
IV. Views
-
General
- Sinuses normally appear black on XRay (air density)
- Opacification or fluid will appear white (fluid density)
-
Maxillary Sinus: Waters' View (Occipitomental XRay)
- Maxillary Sinus visualization
- Water's view alone is usually sufficient for sinus imaging
- May identify Fractures (orbital rim, orbital floor, nasal septum and nasal bones)
- Maxillary Sinus visualization
-
Frontal Sinus: Caldwell-Luc
- Frontal View (PA) with the patient's face against the film
- Best visualizes Frontal Sinus (other sinuses overlap one another on this view)
- Visualizes Fractures of the orbital rim and the medial orbital wall
- Visualizes sagital Suture
- Visualizes Zygomatic Bones, nasal bones, nasal septum and Mandible
- Lateral XRay
- Visualizes ethmoid and Sphenoid Sinuses with the patient seen in profile
- Visualizes coronal Suture and lambdoid Suture
- Visualizes Mandible and nasal bone
V. Interpretation: Findings suggestive of Sinusitis
- Opacification (Only 36-66% sensitive)
- Air fluid levels
- Mucosa more than 8 mm thick (non-specific)
VI. Efficacy: Acute Sinusitis
- Test Sensitivity: 76%
- Test Specificity: 79%
VII. References
- Ouellette and Tetreault (2015) Clinical Radiology, Medmaster, Miami, p. 51-2
- Okuyemi (2000) Am Fam Physician 66(10):1882-6 [PubMed]